Electronic Health Records

Medicare Reimbursement

AMGA Seeks End of MIPS Exclusions to Promote Value-Based Care

February 5, 2019 - AMGA is calling on Congress to implement MACRA and the Quality Payment Program it introduced fully, beginning with the elimination of exclusions from the Merit-based Incentive Payment System (MIPS) that exempted more than half of eligible clinicians. “MIPS was designed as a viable transition tool to value-based payment in the Medicare program, where providers would be rewarded...


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CMS Opens Informal Review Window to Contest PQRS Penalties

by Kyle Murphy, PhD

Previous reporting period for the Physician Quality Reporting System (PQRS) closed at the end of 2014, and the window for eligible professionals (EPs), comprehensive primary care practice (CPC) sites, and practices using the group...

Why EHR Copy-and-Paste Functionality Risks Patient Care

by Vera Gruessner

EHR technology has brought a significant amount of benefits to the healthcare industry from improving data accuracy and patient care to simplifying health information exchange and ensuring greater safety regarding medication prescriptions....

ICD-10 Won’t Significantly Impact MS-DRGs for Two Years

by Jennifer Bresnick

It will be business as usual for MS-DRG assignment for at least another two years after the implementation of ICD-10, says an article published this month in the Journal of AHIMA, since new DRGs mapped to the increased specificity of the...

What is Holding Back ACO Telehealth Use, Reimbursement?

by Kyle Murphy, PhD

ACO telehealth use would enable these risk-based organizations to improve healthcare costs, quality, and access, but regulation restricts its use to rural areas. Telehealth continues to show its ability to improve healthcare costs,...

AHA Loses Case Focused on Medicare Hearings and Appeals

by Kyle Murphy, PhD

The battle between the AHA and HHS over Medicare hearings and appeals heads toward the appeals process. A United States district court has sided with the Department of Health & Human Services (HHS) in the standoff between the federal...

CMS Offers Expanded Telehealth Coverage for Providers

by Jennifer Bresnick

New telehealth services will be included in the Medicare reimbursement plan starting on January 1, 2015. Providers will be able to receive Medicare reimbursement for a new group of services under the telehealth benefit at the beginning of...

ACA cost cutting means Medicare won’t go broke till 2030

by Jennifer Bresnick

Depending on your perspective, there’s some good news and some bad news for healthcare providers and patients who rely on Medicare for their financial and physical health: cost cutting measures encouraged by the Affordable Care Act...

“Era of unhappy doctors” brought on by burnout, revenue woes

by Jennifer Bresnick

Shrinking Medicare reimbursements are sapping the willpower of formally dedicated physicians, asserts cardiologist Dr. Afshine Emrani in an opinion piece for the Jewish Journal, despite many of these physicians adopting robust health IT...

AHA and others continue challenge of the two-midnight rule

by Kyle Murphy, PhD

Several healthcare organizations have redoubled their efforts to challenge the Department of Health & Human Services (HHS) over its implementation and enforcement of the two-midnight rule, according to a summary judgment filed in...

Identifying key stakeholders, activities of claims processing

by Kyle Murphy, PhD

Reimbursement is changing in healthcare. Even before elements of the Affordable Care Act began to go into effect, a growing focus on value versus volume has led many healthcare organizations and providers to consider accountable and...

AHA sues HHS over two-midnight rule, Medicare policies

by Kyle Murphy, PhD

The American Hospital Association (AHA) has increased its advocacy against the two-midnight rule and other Medicare inpatient policies, which now includes a series of complaints filed in United States District Court on Monday. The...

“Two-midnight” Medicare bill brings ire, approval, confusion

by Jennifer Bresnick

CMS has long since learned that it can’t please everyone all the time when it comes to healthcare reform, and its newly released guidance for the oft-delayed “two-midnight” rule is proving the maxim true once again. ...

Complex denials, appeals in RAC process costing hospitals

by Kyle Murphy, PhD

The purpose of the Recovery Audit Program and its Recovery Audit Contractors (RACs) is to identify Medicare overpayments and underpayments across the country, but according to a survey of hospitals by the American Hospital Association...

AAFP: SGR Changes to Meaningful Use May Be an “Improvement”

by Jennifer Bresnick

The American Academy of Family Physicians is joining the growing number of organizations heartily approving Congressional action to restructure the way Medicare reimburses physicians and rewards them for high quality outcomes.  After...

Support for SGR repeal bill builds among physician societies

by Jennifer Bresnick

The American College of Physician Executives (ACPE) and American Academy of Ophthalmology (AAO) have joined the American Medical Association (AMA) in adding their support for the SGR Repeal and Medicare Modernization Act of 2014, the...

AMA supports SGR repeal, merit-based incentive system

by Kyle Murphy, PhD

The American Medical Association (AMA) is throwing its support behind a bill recently introduced into Congress that would repeal the sustainable growth rate and support the creation of a single system to manage the disbursement of...

Will managing risk consume too many healthcare resources?

by Kyle Murphy, PhD

Executive leadership at healthcare organizations view regulatory changes and increased regulatory scrutiny as a major strategic risk and one that is going to impact spending across the organization, according to a survey conducted by North...

Pathway for SGR Reform Act provides 3-month Medicare fix

by Jennifer Bresnick

A bi-partisan effort to postpone the yearly threat of major cuts to Medicare payments has succeeded in holding off the steep payment reductions for another three months after President Obama’s signature affixed itself onto the Pathway...

Ordering, referring denial edits will begin Jan. 6, 2014

by Nicole Freeman

The Centers for Medicare and Medicaid Services (CMS) has announced a January 6, 2014 starting date for the second phase of denial edits. Here is the full message from CMS: CMS will instruct contractors to turn on Phase 2 denial edits...

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