Medicare

CMS will pay $1.9 billion to hospitals in value-based payments for inpatient care

Susan Morse for Healthcare Finance Hospitals will receive $1.9 billion in value-based incentive payments for inpatient care, the Centers for Medicare and Medicaid Services announced yesterday. More hospitals will receive positive payment adjustments in 2020 than negative, CMS said. More than 1,500 hospitals (over 55%) will receive higher Medicare payments under the Hospital Value-Based Purchasing…

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CMS penalizes 2,583 hospitals for high readmissions: 5 things to know

By Ayla Ellison for Becker’s Hospital Review In fiscal year 2020, CMS will penalize 2,583 hospitals for having too many Medicare patients readmitted within 30 days, according to federal data released Sept. 30 cited in a Kaiser Health News report. This is the eighth year of the Hospital Readmissions Reduction Program. To determine penalties for…

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The top financial pressures facing healthcare organizations: 5 leaders discuss

By Kelly Gooch for Becker’s Hospital Review Becker’s Hospital Review asked healthcare leaders to share the factors they believe will pressure hospital finances the most in 2019. Here are their responses, presented alphabetically. Editor’s Note: Responses have been lightly edited for length and clarity. Dawn Bulgarella CFO of the UAB Health System (Birmingham, Ala.) Hospital…

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DRG Mismatches

By Cheryl Ericson, MS, RN, CCDS, CDIP for For the Record When discrepancies occur, the ensuing reconciliation process serves as a prime opportunity to educate CDI and coding staffs. Reconciliation rates monitor both clinical documentation improvement (CDI) and coding proficiency, a key performance indicator. However, many in leadership positions overlook the importance of trending reconciliation…

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Hospitals slammed with $380M in CMS cuts, industry cries foul

By Samantha Liss for Healthcare Dive Dive Brief: With its final Outpatient Prospective Payment System (OPPS) rule for 2019, CMS is eliminating the pay discrepancy Medicare beneficiaries face visiting a hospital-owned outpatient setting as opposed to a traditional doctor’s office. CMS said cutting reimbursement at hospital-owned outpatient settings for these visits will save Medicare $380 million…

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CMS bid to overhaul E/M codes leaves few happy

With its proposed changes to payments and documentation for office visits, the agency is effectively forcing providers to reckon with a longstanding, oft-disputed problem. By Tony Abraham for Healthcare Dive Most healthcare players agree the evaluation and management billing codes used by CMS need an overhaul, but few like the manner to do so proposed…

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8 most common medical coding errors

By Morgan Haefner for Becker’s Hospital Review In June, federal officials charged 601 defendants in alleged schemes involving about $2 billion in costs to Medicare and Medicaid, the biggest healthcare fraud enforcement action in U.S. Justice Department history. Government and private health insurer audits have recently revealed several fraudulent or abusive medical billing practices, Kevin B. O’Reilly, editor…

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Health Care Goodfellas: Mafia Turns to Medicare Fraud

By Edecio Martinez for CBS News MIAMI (AP) Lured by easier money and shorter prison sentences, Mafia figures and other violent criminals are increasingly moving into fraud involving the government’s Medicare health insurance program for the elderly. Around the U.S., federal investigators have been threatened, an informant’s body was found riddled with bullets, and a woman was…

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CMS finalizes rule requiring hospitals to post prices online

By Tony Abraham for Healthcare Dive Dive Brief: CMS on Thursday issued its final rule on the Inpatient Prospective Payment System, cementing the agency’s April proposal to increase transparency by pushing hospitals to post standard charges online in a machine-readable format. The rule doesn’t require posting any more information than hospitals are already mandated to provide…

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