Posts Tagged ‘CMS’
CMS announces new payment model for primary care physicians
The Centers for Medicare and Medicaid Services (CMS) last week announced a new risk-based primary care initiative designed to “transform and improve†how primary care physicians care for their patients by focusing on quality of care and outcomes over how many patients a physician can see in a given day. Dubbed the Comprehensive Primary Care…
Read MoreCMS proposes new payment model for Medicare Part B
The Centers for Medicare and Medicaid (CMS) is proposing a new rule that could result in a new Medicare Part B drug payment model. Published in the Federal Register, the agency is proposing a two-phase model that would test whether alternative drug payment designs would result in a reduction in Medicare costs, while at the…
Read MoreCMS issues new condition code for home health claims
The Centers for Medicare and Medicaid Services (CMS) has added a new condition code that will allow home health claims for subsequent episodes to process, even if skilled nursing services are not required. The change takes effect July. 1 Currently, any home health claim that is submitted without skilled nursing visits are automatically returned to…
Read MoreCMS clarifies 60-day overpayment rule
The Centers for Medicare & Medicaid Services (CMS) has published its long-awaited final rule that details the reporting and returning of Medicare Part A and B overpayments. The proposed rule left providers asking many questions. The final rule provides needed clarity and consistency in the reporting and returning of self-identified overpayments. It is designed to…
Read MoreHow data mining is uncovering healthcare fraud
What does your data say about your healthcare practice? Does it show that you bill considerably more than your colleagues for certain types of procedures? What about your facility? Is it performing more of a particular procedure than nearby competitors? These days, healthcare fraud investigators increasingly rely on data to root out healthcare fraud. They…
Read MoreFinalized DME rule targets fraud, abuse
The Centers for Medicare and Medicaid Services has finalized a rule that creates a prior authorization process for some durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that it has determined are often subject to unnecessary utilization – i.e. healthcare fraud. The rule was first proposed in May 2014 and included a Master List of…
Read MoreICD-10: How is your practice handling the transition?
It’s been a few weeks since the launch of ICD-10 and there have been a number of stories written about some of the challenges that healthcare providers are facing and how the new billing codes are having an impact on their practices and patient care. Although still early in its implementation, it appears those who…
Read MoreOMHA to expand Medicare appeals process
Faced with skyrocketing processing times, the Office of Medicare Hearings and Appeals (OMHA) says it plans to expand its Settlement Conference Facilitation pilot project in an effort to clear through the ever-growing backlog of claims appeals. The pilot project, which began in June 2014, is an alternative dispute resolution process. It was created to bring…
Read MoreCMS: Medicare ACOs find success in savings, improved quality
The recent news that Medicare Accountable Care Organizations (ACOs) generated net savings of $411 million in 2014 and improved in most quality measures is being hailed as a success by the Centers for Medicare and Medicaid (CMS). These ACOs, which were established under the Affordable Care Act, are the center of the nation’s healthcare reform…
Read MoreBundled payments: What impact will they have on your practice?
In an effort to shift payment models away from fee-for-service, more healthcare providers are being paid based on their ability to provide high-quality care in a more coordinated fashion through bundled payment arrangements. To that end, The Centers for Medicare & Medicaid Services (CMS) recently announced that more than 2,100 acute care hospitals, skilled nursing…
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