CMS system edits helped reduce Medicare overpayments to acute care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, a report from the Office of...
As medical groups expect to see Medicare payment cuts in 2023, practices are considering limiting the number of new Medicare patients and reducing clinical staff to ensure financial stability,...
Prominent medical societies, including the American Medical Association (AMA), are suing private payer Cigna over chronic underpayments to physicians participating in one of their networks.
The class...
State surprise billing laws that allow arbitrators to consider provider charges when determining out-of-network payment amounts for surprise medical bills led to an increase in billed charges for...
The American Medical Association (AMA) has released the Current Procedural Terminology (CPT) code set for 2023, which contains updates that aim to reduce medical coding burden for evaluation and...
Time-based billing was associated with higher physician reimbursement for longer evaluation and management (E/M) visits, while billing based on medical decision-making (MDM) led to higher reimbursement...
The American Medical Association (AMA) and other physician advocacy groups are calling on CMS to reverse proposed Medicare Physician Fee Schedule updates, which would slash Medicare payment for...
The American Medical Association (AMA) has announced an editorial update to its Current Procedural Terminology (CPT) code set to include eight new codes for the bivalent COVID-19 vaccine doses from...
The American Hospital Association (AHA) has asked the US District Court for the District of Columbia to order HHS to immediately halt underpayments to hospitals participating in the 340B Drug Pricing...
CMS reported collecting only half of the $498 million in Medicare overpayments identified by the Office of Inspector General (OIG), according to an OIG audit.
The OIG audit was a follow-up to a...
The American Medical Association (AMA) has updated the Current Procedural Terminology (CPT) code set to include a laboratory test CPT code for the orthopoxvirus and two CPT codes for the monkeypox...
A bipartisan group of 25 House members has asked HHS to clarify its plans regarding the enforcement of Medicare’s 96-hour payment rule for critical access hospitals (CAHs) following the end of...
Medicare inpatient reimbursement cuts slated to take effect in the 2023 fiscal year would threaten access to care at hospitals, which are already facing substantially higher costs because of the...
Claim denial rates varied significantly among Healthcare.gov marketplace payers, with some insurers racking up rates as high as 80 percent, according to a new analysis from Kaiser Family...
The American Hospital Association (AHA) has asked HHS to ensure 340B hospitals receive timely repayment following the Supreme Court’s decision that the department’s 340B Medicare...
In a narrow ruling, the Supreme Court recently sided with HHS in a case challenging a multi-billion dollar cut to Medicare payments to safety-net hospitals.
The Court ruled 5 to 4 that HHS did have...
The American Hospital Association (AHA) has asked CMS to make several adjustments to the proposed Hospital Inpatient Prospective Payment System (IPPS) payment updates for fiscal year 2023, including...
Medicare and its beneficiaries paid significantly higher prices at provider-based facilities than they would have paid to freestanding facilities for the same services, according to a report from the...
The US Supreme Court has sided with the American Hospital Association (AHA) and other hospital groups and determined that the 340B Medicare reimbursement cuts for hospitals were unlawful.
In the 2018...
The American Hospital Association (AHA) has urged CMS not to cut Medicare payments for skilled nursing facilities in fiscal year 2023, as the agency put forth in its Skilled Nursing Facility (SNF)...
