Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Reimbursement News

ESRD Orgs May See Higher Medicare Reimbursement, Drug Payments

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A new proposal from CMS would increase Medicare reimbursement to end-stage renal disease (ESRD) facilities by $220 million and change the way the federal agency pays the facilities for new renal dialysis drugs. The proposed update to the...

CMS OKs Medicaid Reimbursement for Substance Use Treatment in NH

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CMS recently approved a five-year Section 1115 demonstration allowing New Hampshire to provide Medicaid reimbursement to more behavioral health facilities for substance use disorder treatment services. The approval authorizes the Granite...

Stakeholders Want Greater MIPS Participation for Higher Rewards

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Policymakers and industry groups are calling on CMS to include more Medicare providers in MACRA’s Merit-Based Incentive Payment System (MIPS). Five members of Congress, all of whom are part of the House GOP Doctors Caucus, recently...

NJ Passes Medicaid Reimbursement Cap on Non-Emergent ED Services

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Hospital emergency departments are one of the most expensive care settings, and New Jersey policymakers are trying to ensure providers only get paid for delivering emergency services to patients who truly need them. The Garden...

How Part B Drug Changes Could Impact Provider Reimbursement

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Healthcare industry experts are warning the Trump Administration that its proposal to transfer some drugs covered by Medicare Part B to Part D would have a negative impact on provider reimbursement and care quality. In the Trump...

Federal Policies to Decrease Hospital Payments by $218B by 2028

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Several federal policies since 2010 will reduce hospital payments by a total of $218.2 billion by 2028, a new report from the health economics consulting firm Dobson | DaVanzo and Associates revealed. The report commissioned by the...

Electronic Claims Management Adoption Could Save Providers $9.5B

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Transitioning from manual to fully electronic claims management would save the healthcare industry $11.1 billion annually, with providers seeing the greatest share of the savings, the fifth annual CAQH Index found. Providers would save...

Level the Playing Field for Medicare Advantage in MACRA, Orgs Urge

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Eleven industry groups are urging CMS to include Medicare Advantage (MA) in MACRA as soon as possible to provide the same incentives to eligible clinicians in risk-based MA models as those offered to clinicians in Medicare Advanced...

Fixing Medicare, Medicaid a Top Priority for New Coalition

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Healthcare industry heavy-hitters are partnering to form a new coalition that generally aims to “improve what’s working in health care and fix what’s not,” especially in Medicare, Medicaid, and other government...

Oncologist Org Fights Medicare Reimbursement Cut to Cancer Drugs

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A group representing over 5,000 independent, community-based oncologists is suing HHS over the implementation of a two percent sequester cut to Medicare reimbursement for Part B cancer drugs. The Community Oncology Alliance (COA) is...

ER Spending Rose 99% Since 2009 Despite No Change in Utilization

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Emergency room (ER) spending per person grew 99 percent between 2009 and 2016 despite ER utilization remaining the same during the period, new data from the Health Care Cost Institute (HCCI) revealed. “Emergency room visits are not...

Expanded Resolution Process Opens to Lower Medicare Appeals Backlog

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HHS recently announced an expanded alternative dispute resolution process that aims to reduce the growing Medicare appeals backlog. The expanded Settlement Conference Facilitation (SCF) process promises to streamline Medicare dispute...

Half of PCPs Aware of Medicare Reimbursement for Chronic Care Mgmt

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CMS recognized that chronic disease management is key to lowering healthcare costs and improving patient outcomes by creating a Medicare reimbursement code for chronic care management. However, provider knowledge of the payment is...

Primary Care Physician Shortage Driving Bump in Compensation

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Primary care physician compensation increased by more than 10 percent over the past five years. But the rise in pay indicates a worsening primary care physician shortage, according to the 2018 DataDive Provider Compensation report from the...

CMS OKs Maryland’s All-Payer Alternative Payment Model Expansion

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CMS greenlighted an expansion of an all-payer alternative payment model in Maryland that allows the state to set hospital reimbursement rates, the office of Governor Larry Hogan recently announced. Maryland’s unique alternative...

Most Physicians Will Not Drop Payer Contract Despite Poor Pay

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Provider organizations should be monitoring their payer contracts to ensure fair reimbursement, but most physicians still would not drop a payer if they were paying poorly, a recent Medscape survey found. The poll of 20,000 physicians...

Hospitals Wait 16 More Days for Late Payments from Claim Denials

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Delayed payments stemming from claim denials are significantly impacting hospital revenue cycles, taking an average 16.4 more days to pay compared to claims that have not been denied, a new analysis from Crowe Horwath revealed. The...

CMS Proposes Patient-Driven Pay for Skilled Nursing Facilities

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CMS recently proposed updates to several post-acute care prospective payment systems, with skilled nursing facilities seeing a potentially new Medicare reimbursement arrangement, called the Patient Driven Payment Model. The Patient Driven...

CMS Seeks Info on a Direct Provider Contracting Model for Medicare

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CMS is seeking comments on a potential alternative payment model that would allow primary care providers to directly bill Medicare beneficiaries through a direct provider contracting model. Currently, providers must opt out of Medicare...

AMA, ASAM Create Alternative Payment Model for Opioid Use Disorder

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The American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) recently unveiled an alternative payment model that aims to improve care and reduce costs associated with opioid use disorder. The new...

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