Tag: CMS

Reimbursement & Regulations: E&M, Social Determinants of Health, Kickbacks

By: Andrew Minten JD
Date: December 7, 2018
Category: Custom Services
Filed under: 2019 MPFS, CMS, E/M, E&M, HHS, Inpatient Billing, Kickbacks, Medicaid, Medicare, OIG Work Plan, Reimbursement & Regulations, Social determinants of health

Return readers will be happy to hear that the CMS is delaying its changes to E&M payments. In the 2019 Medicare Physician Fee Schedule Final Rule, the CMS stated it will not be reducing E&M payments from five levels to two, but to three levels, and that it will not be doing it until 2021. […]

What Do the Midterms Mean for the Future of Medicaid Work Requirements?

By: Courtney Zott and Anna Miller
Date: November 20, 2018
Category: Market Events
Filed under: CMS, medicaid work requirements, midterm elections

A federal policy guidance document released by CMS in January 2018 showed states how to implement Medicaid work requirements, sparking a wave of proposals from Republican-led state legislatures to require certain enrollees to complete work or community engagement activities. Some states have already garnered federal approval, while others are waiting for authorization, though the results […]

Reimbursement & Regulations: Sepsis, Medicare Part C, MBIs

By: Andrew Minten JD
Date: November 2, 2018
Category: Custom Services
Filed under: Anthem, CMS, DSH, HHS, MBI, Medicare, Medicare ID Cards, Medicare IDs, Medicare Part C, Reimbursement & Regulations, Sepsis, Sepsis-3, United Healthcare

Starting January 1, United Healthcare will use sepsis-3 criteria for the medical necessity of claims. Experts believe this could lead to higher denials in the near future. This change is for all of United Healthcare’s plans. Sepsis-3 defines sepsis as “life-threatening organ dysfunction caused by dysregulated host response to infection [suspected or confirmed].” Two standards […]

Reimbursement & Regulations: Emergency Plan, H&P, & Transplant Centers

By: Andrew Minten JD
Date: October 12, 2018
Category: Custom Services
Filed under: CMS, Emergency Plans, Emergency Preparedness, Medical History and Physical Examination, Reimbursement & Regulations, Transplant Centers

Since the OIG only has two new Work Plan focuses this month, and because neither deal with hospital reimbursement on a broad level, this month I will only focus on a new Rule proposed by the CMS. On September 20, 2018 the CMS released a new proposed rule with the purpose of reducing more of […]

Three Lessons You’ll Learn During HBI’s Price Transparency Roundtable

By: Courtney Zott
Date: October 8, 2018
Category: Revenue Cycle
Filed under: CMS, price estimation, Price Transparency

Hospital prices have been coming under increased scrutiny amid rising patient consumerism and regulatory attention. Most recently, CMS issued a new regulation requiring providers to publicize standard charges online on January 1, 2019. In this climate of transparency, organizations’ strategies for informing patients of their care costs are more important than ever. Leaders from University […]

Reimbursement & Regulations: Price Transparency, IMRT planning, E&M

By: Andrew Minten JD
Date: September 7, 2018
Category: Custom Services
Filed under: charges, CMS, E&M, IMRT, Medicare, OIG, OIG Work Plan, Price Transparency, Radiation Therapy, Reimbursement & Regulations

The CMS has made final their rule to require all hospitals to publish a list of standard charges in a machine-readable format online at least once a year. This requirement will be in place as of January 1, 2019, so it is important to get your organization moving. The CMS created this rule in order […]

Helping Patients During the Transition to New Medicare Cards

By: Kelli Jenkins
Date: August 3, 2018
Category: Revenue Cycle
Filed under: CMS, Medicare, Medicare Beneficiary Identifier, Medicare Cards, Patient Identification

Since April 2017, CMS has been rolling out its new Medicare beneficiary cards in phases to a variety of states and territories of the U.S., and many are still awaiting their arrival. As some healthcare organizations begin to encounter patients with new cards and many more prepare to, leaders may be wondering what impact—if any—this […]

CMS’ 2019 Physician Fee Schedule Proposal: What Providers Should Know

By: Courtney Zott
Date: July 18, 2018
Category: Revenue Cycle
Filed under: CMS, Medicare, physician fee schedule

CMS proposed multiple changes last week to physician coding, documentation, and reimbursement in its proposed Physician Fee Schedule and Qualified Payment Program updates for 2019. Under the new rules, the agency would: Reimburse for certain telehealth services. Specifically, providers would receive payment for brief virtual check-ins via phone or other telecommunication device and for time […]

Reimbursement and Regulations: Value-Based Reimbursement, Price Transparency, and OIG Updates

By: Andrew Minten JD
Date: June 1, 2018
Category: Custom Services
Filed under: 2019 IPPS, chargemaster, CMS, Humana, IPPS, noninvasive home ventilators, OIG, OIG Work Plan, outpatient cardiac and pulmonary rehabilitation services, Price Transparency, reimbursement, Reimbursement & Regulations, respiratory assist devices, value-based care, value-based reimbursement

Though the transition from fee-for-service to value-based care is dreadfully slow (which makes sense with how many factors there are to juggle), commercial payers have been stepping up to the plate. Aetna and United Healthcare have stated that more than 45% of their total annual medical spend is in value-based contracts. As a recent highlight, […]