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

Reimbursement News

Hospitals Still Facing Medicare Claims Denial Management Issues

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A recent American Hospital Association (AHA) survey indicated that hospitals are still experiencing challenges with Medicare claims denial management under the Recovery Audit Program. The survey of 676 hospitals revealed that about 60 percent...

Impact of Quality Payment Program on Medicare Reimbursement

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With the final rule on MACRA implementation finally emerging, eligible clinicians were presented with a range of Quality Payment Program participation options that would impact Medicare reimbursement payment adjustments in 2019. The Quality Payment...

Higher Medicare Reimbursement Not Related to Better Quality

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According to a recent study in JAMA Surgery, Medicare reimbursement amounts for patients who were rescued from surgical complications were two to three times greater at the highest cost-of-rescue hospitals, even though patient outcomes were similar...

OIG: Add Medical Device Data to Claims Reimbursement Forms

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Claims reimbursement forms lacking appropriate fields for medical device information make it more difficult for CMS to reduce Medicare spending associated with recalled or failed devices, the Department of Health and Human Services (HHS) Inspector...

Bundled Payments Model Cuts Joint Replacement Costs by $1,166

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Hospitals participating in the Bundled Payments for Care Improvement initiative decreased Medicare spending on lower extremity joint replacement hospitalizations by $1,166 per episode compared to non-participating hospitals, reported a study...

Group Calls for Dual-Eligible Claims Reimbursement Changes

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In a recent report, the Bipartisan Policy Center’s Health Project has urged federal officials to improve care delivery for dually eligible Medicaid and Medicare beneficiaries by revising claims reimbursement models to better align with...

Court Denies HHS Wish to Delay Medicare Appeals Backlog Case

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A federal district court recently denied a request from the Department of Health and Human Services (HHS) to postpone proceedings on a Medicare appeals backlog case until Sept. 30, 2017, according to the court’s decision. US District Judge...

AHA Urges CMS to Withdraw Uncompensated Care Payment Changes

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The American Hospital Association (AHA) recently penned a letter to CMS Acting Administrator Andy Slavitt urging the federal agency to withdraw its proposed rule to include third-party payments, such as private payer and Medicare reimbursements,...

CMS Releases DMEPOS Medicare Reimbursement Rates, Contracts

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CMS has announced new Medicare reimbursement rates for some medical equipment items and started to send contract offers to winning bidders for Medicare’s Round 1 2017 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)...

AMGA: Tie Medicare Reimbursement to Care Coordination Metrics

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According to two comment letters to CMS, the American Medical Group Association (AMGA) has urged the federal agency to better align Medicare reimbursements and value-based incentive payments to promote enhanced care coordination. The industry...

Adjusted DMEPOS Payments to Reduce Medicare Spending by $19M

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Medicare spending would decrease by approximately $19 million a year once CMS fully implements new claims reimbursement rates for accessories associated with some durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), reported...

MedPac Suggests More Claims Reimbursement Cuts for Home Health

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The Medicare Payment Advisory Commission (MedPac) is advising CMS to deepen proposed Medicare reimbursement cuts to home health advisors to better align with actual costs and compensate for systematic overpayments. The call for more reductions...

Can Changes to Medicare Reimbursement Appeals Reduce Backlog?

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The lengthy Medicare reimbursement appeals process poses significant revenue cycle management problems for many providers, yet new proposed fixes from HHS may not do much to solve the problem, argue several industry groups. In June, HHS proposed...

GAO: Drug Couponing Affecting Medicare Reimbursement Rates

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The methodology for calculating Medicare reimbursement to providers for prescription drugs under the Part B program may be contributing to higher Medicare spending because it does not account for the impact of coupon programs, according to recent...

AHA: Delay Site-Neutral Rule to Address Medicare Fraud Risks

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The American Hospital Association (AHA) has asked CMS to delay the implementation of proposed site-neutral payments for another year because the payment reform rule could increase a hospital’s Medicare fraud and abuse risks. Site-neutral...

AHA Critiques Medicare Reimbursement Changes for Home Health

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The American Hospital Association (AHA) is urging CMS to delay outlier provisions and streamline certain medical billing procedures proposed in a recent document aimed at home health facilities. In June, CMS released a proposed rule that would...

Providers Save Healthcare Costs via Medication Adherence

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Developing chronic disease and population health management programs is key to achieving value-based care, but a new study in the American Journal of Managed Care found that the programs themselves must also be cost-effective to maximize reductions...

How Emergency Providers Can Adopt Alternative Payment Models

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With many value-based care initiatives aiming to reduce costly emergency room visits, some emergency departments are finding it increasingly difficult to engage with alternative payment models, according to a report in the American Journal of...

Team-Based Primary Care Cuts FFS Healthcare Revenue by 2.5%

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As healthcare providers continue to transition to value-based care, many hospitals and physician practices have focused on how to improve care coordination and team-based approaches to improve patient outcomes and boost their healthcare revenue...

Driven by Specialists, Physician Compensation Rates Rise 3.1%

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Physician compensation has increased by 3.1 percent in 2015, according to a recent survey from the American Medical Group Association (AMGA). The rate represents a 0.3 percent increase from last year. “Once again this year, we see that...

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