Mitigating Increasing Readmissions to Avoid Reduced Reimbursement

CMS released the results for year five of the Hospital Readmissions Reduction Program.  Here is what you need to know: What was covered? CMS examined hospitals’ 30-day readmission rates for seven conditions: Heart attacks Heart failure Pneumonia Chronic lung disease Hip and knee replacements Coronary artery bypass graft surgery What...

2017 IPPS Rule Released

The Centers for Medicare & Medicaid Services (CMS) released the FY 2017 IPPS Rule this week (accessible at https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-18476.pdf). Key things to be aware of in the 2,434 pages: Two-midnight rule inpatient pay cuts were not adopted Financial benefits and penalties related to the reporting of quality data and meaningful...

The Cardiac Bundle – What You Need to Know

Just as many hospitals are adjusting to the Comprehensive Care for Joint Replacement (CJR) bundled payment model, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on the next bundled payment model – the cardiac bundle (bypass surgeries and heart attacks). Many in the industry are not...

Limit Denials through Proactive, Pre-Bill Auditing

The Department of Health and Human Services (“HHS”) issued a proposed rule, published in the Federal Register on July 5th, to change Medicare appeals procedures in an attempt to make the process more streamlined and efficient.  Currently, the HHS Office of Medicare Hearings and Appeals (“OMHA”) has a backlog of...

OIG Issues Spring 2016 Semi-Annual Report

Recently the Health and Human Services (“HHS”) Office of Inspector General (“OIG”) issued its Spring 2016 Semi-Annual Report (“Report”) to Congress for the six-month period ending March 31, 2016. The OIG is mandated to report on a semiannual basis to Congress on the administration of HHS’ programs. The Report summarizes...

Coding Clinic Updates: Significant Changes to CHF and Diabetes Coding

Coding Clinic 1st Quarter 2016 Updates The release of Coding Clinic 1st Quarter 2016 (effective with discharges which started on March 18, 2016) brought about two significant changes. Heart Failure The first change is the acceptance of the more contemporary heart failure classification terms that refer to ejection fraction and...

What Accountable Care Organizations Need to Know About the MSSP Final Rule

On June 6, 2016, the Centers for Medicare & Medicaid Services (CMS) issued its final rule (accessible at, https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-13651.pdf) strengthening incentives for Accountable Care Organizations (ACO) in the Medicare Shared Savings Program (MSSP). According to the CMS Acting Administrator, the changes “will encourage more physicians to improve patient care by...

HHS’s Cyber Security Efforts Examined by Subcommittee on Health

Recently, a number of hospital computer systems have been hacked and the hackers demanded ransomware. Wichita-based Kansas Heart Hospital is one of the hospitals that decided to pay the “small” ransom after the hackers locked files, a decision that the FBI does not recommend. This latest cyber-attack occurred just one week prior to...

Medicare and Medicaid Program Integrity

On May 24th, the Subcommittee on Oversight and Investigation held a hearing entitled “Medicare and Medicaid Program Integrity: Combatting Improper Payments and Ineligible Providers.” The hearing was held based on recent reports from the Government Accountability Office (“GAO”) and the Department of Health and Human Services (“HHS”) Office of the...

Staying Up-To-Date on MACRA

This past week, the Acting Administrator of the Centers for Medicare & Medicaid Services (CMS) took to social media to provide 4 Key Takeaways on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the comment period: Reminder that providers have the opportunity to invite representatives from CMS...

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Leveraging our deep operational experience and real world understanding of the regulatory landscape, Provident partners with our clients to meet the diverse challenges of the evolving healthcare industry. With proven solutions, expertise, innovative thinking, and specialized tools and techniques the Provident team works collaboratively with clients to optimize their financial and operational performance.

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