CMS wants to identify bad actors -– even if they are or have been affiliated with a legitimate provider. On Sept. 5, the Centers for Medicare & Medicaid Services (CMS) issued a new final rule. There was not really a proposed rule to which comments and suggestions could be made; there were Federal Register entries […]
Hospitals assuming downside financial risk under value-based care models is the key to lowering healthcare costs and improving quality, CMS believes. CMS Administrator Seema Verma urged hospitals on Tuesday to accept new value-based care models and price transparency requirements or face greater administrative burden, less competition, and lower reimbursement rates under Medicare for All. “Our choices are […]
Improving revenue cycle performance has become more challenging amid today’s healthcare payment trends and patient financial expectations. To gauge efforts at hospitals and health systems, Becker’s Hospital Review asked healthcare leaders to share changes their organizations have made to improve revenue cycle performance this year. Read their responses below, presented alphabetically. Venkat Bhamidipati Executive vice president and […]
HIV/AIDS payments, in particular, are under the microscope. The new Patient-Driven Payment Model, or PDPM, makes radical changes to the Medicare payment model for nursing homes. One of the largest changes is the reimbursement rate for services provided to HIV and AIDS patients. In 2016, there were 15,807 deaths among people with diagnosed HIV in […]
A physician assistant (PA) serves as an assistant surgeon only to suture and close an incision. There is no documentation that the PA performed any other function to assist the primary surgeon during the surgery performed on the Medicare patient, such as providing extra hands needed for tasks which required more than the surgeon’s two […]
Discover the must-watch list for coding bug bites, poison ivy, and heatstroke! Get ICD-10 pointers. Can you believe it’s already mid-August? While the buzz around 2020 code updates is in the air, let’s not forget about the remaining summer of 2019. How many of these common warm-weather diagnoses have you encountered and coded this year […]
An overview of the proposed Medicare Physician Fee Schedule: The proposed Medicare Physician Fee Schedule (MPFS) rule for 2020 was officially released on Aug. 14, 2019, encompassing various elements. Among these are proposals such as adjusting the PFS conversion factor to $36.09, introducing new HCPCS codes for bundled episode-of-care treatment for opioid use disorders, revising […]
The Centers for Medicare & Medicaid Services (CMS) has proposed changes to the payment structure for sinus endoscopy services in the 2020 Physician Fee Schedule (PFS) proposed rule (page 53). Specifically, CMS intends to apply multiple endoscopy rules, similar to those used for colonoscopies, to sinus endoscopy reimbursements. This approach is detailed in MLN Matters […]
In the crowded healthcare market, smart healthcare leaders must find patient satisfaction advantages everywhere they can. When it comes to patient satisfaction, providing excellent clinical care is a no-brainer. But in a crowded and competitive healthcare market, smart healthcare leaders know that they need an edge everywhere, including an efficient revenue cycle. That’s the case […]
Final rules will impact nearly every type of healthcare provider. The Centers for Medicare & Medicaid Services (CMS) presented us with quite a number of Medicare payment rules in the last week or so, referencing almost every type of provider in the program. The final rules included the Fiscal Year (FY) 2020 Medicare Hospital Inpatient […]










