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

Reimbursement News

OIG: NJ Agency Falsely Claimed $95M in Medicaid Reimbursement

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New Jersey’s Department of Health and Human Services may have to repay the federal government almost $95 million after the Office of the Inspector General (OIG) recently found that the state agency received improper Medicaid reimbursement...

Net Medicare Improper Payment Recoveries Dropped 91% in 2015

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Medicare improper payment recoveries saw a significant drop in 2015, according to a recent CMS report to Congress. The Recovery Audit Contractor (RAC) program returned 91 percent less to Medicare during the 2015 fiscal year compared to 2014....

OIG Finds Medicare Payment Problems with Two-Midnight Policy

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Hospitals may face more Medicare reimbursement audits on inpatient and outpatient claims after the Office of the Inspector General (OIG) recently found several vulnerabilities associated with the Two-Midnight policy. Using hospital and provider...

AHA Asks CMS to Increase Site-Neutral Medicare Reimbursement

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The American Hospital Association (AHA) recently advised CMS to increase Medicare reimbursement rates to off-campus provider-based outpatient departments that will be paid under site-neutral payment rules starting on Jan. 1, 2017. The industry...

Medicaid, Medicare Reimbursement $57.8B Below Hospital Costs

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Medicaid and Medicare reimbursement in 2015 was under actual hospital costs for treating beneficiaries by $57.8 billion, the American Hospital Association (AHA) recently reported. According to data from the AHA’s Annual Survey of US Hospitals,...

Judge Calls for Medicare Appeals Backlog Elimination by 2020

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The Department of Health and Human Services (HHS) must eliminate the Medicare appeals backlog at the administrative law judge review level by Dec. 31, 2020, a federal judge recently decided. The most recent decision ends a two-and-a-half-year...

Do Medicaid Reimbursement, Admissions Produce Hospital Profit?

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Do Medicaid reimbursement rates and federal uncompensated care payments really cover the healthcare costs of treating larger proportions of Medicaid beneficiaries and uninsured individuals? Two new studies in Health Affairs indicate yes, but...

NY Senator Challenges Rural Medicare Reimbursement Repayment

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New York Senator Charles Schumer (D-NY) recently spoke out against a CMS plan to recoup supplemental Medicare reimbursement to rural hospitals that could cause hospitals in New York alone to repay the federal agency $15 to $20 million for payments...

CMS Proposes to Limit Supplemental Medicaid Reimbursement

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CMS recently proposed a rule that would limit a state’s ability to create or increase a Medicaid reimbursement structure for hospitals, physicians, and nursing homes that pays providers for services that are not related to care delivery...

Payment Reform Suggestions to Improve Complex Pediatric Care

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Payment reform for medically complex children is needed to support a more family- and patient-centered care delivery model that requires extensive care coordination and non-face-to-face services, a new study in Pediatrics indicated. Researchers...

Tips for Negotiating Claims Reimbursement Rates with Payers

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Every dollar counts in the healthcare revenue cycle, especially with declining Medicare reimbursement rates and new value-based care models. But organizations should understand how to successfully negotiate claims reimbursement contracts with...

CMS Reduces Inpatient Medicare Improper Payment Rate by 58%

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In a recent official blog post, CMS touted that the Medicare improper payment rate for inpatient hospital claims fell by 58.3 percent between 2014 and 2016. While Medicare inpatient hospital claims accounted for $10.45 billion in improper payments...

CMS Updates Site-Neutral Payment Reform Implementation Rule

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In a recent ruling on the outpatient prospective payment system, CMS finalized several changes to the site-neutral payment reform policy under which most provider-based hospital outpatient departments will no longer receive outpatient Medicare...

CMS Offers 66% Settlement to Reduce Medicare Appeals Backlog

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In an effort to resolve the Medicare appeals backlog, CMS recently reopened a settlement option that would allow hospitals to receive partial reimbursement for some claim denials currently stuck in the appeals process. Similar to the 2014 settlement...

CMS Issues Final Rule on Home Health Medicare Reimbursement

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CMS recently released a final rule that will reduce Medicare reimbursement to home health providers by $130 million, or 0.7 percent, in 2017. Lower Medicare spending on home health services will stem from updates to payment rates, the Home Health...

Senate Group Drafts Chronic Disease Management Payment Reform

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The Senate Finance Committee Chronic Care Working Group recently released a draft healthcare payment reform bill targeting chronic disease management programs and services, such as the Independence at Home Model, telehealth consultations, accountable...

CMS Updates ESRD, Dialysis Medicare Reimbursement Policies

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End-stage renal disease (ESRD) and dialysis providers can expect a 0.73 percent increase in total payments compared to last year under new Medicare reimbursement rates, CMS recently announced. Medicare spending on ESRD payments is projected to...

25% of Healthcare Payments Tied to Alternative Payment Models

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Only one-quarter of healthcare payments in 2016 will be connected to an alternative payment model that has population-based accountability, reported the Healthcare Payment Learning & Action Network (LAN). The survey of over 70 commercial,...

Patients Find Medicare Reimbursement to Surgeons Too Low

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Patients may be willing to pay more out-of-pocket expenses for certain medicals services, such as knee surgeries, especially as providers face lower Medicare reimbursement rates, a recent study in Orthopedics contended. The survey of 231 patients...

AHA Offers HHS Solutions to Reduce Medicare Appeals Backlog

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The American Hospital Association (AHA) recently advised the Department of Health and Human Services (HHS) to implement three solutions that would significantly reduce the Medicare appeals backlog at the administrative law judge level. The potential...

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