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CMS Confirms Mandatory Medicare Bundled-Pay For Joint Replacement Surgery

CMS finalized the proposed bundle payment system for its hip and knee replacement surgery known as the CCJR model on November 16. Even though the final rule makes some changes to the model, which was proposed at the start, by reducing the number of participating metropolitan statistical regions from 75 to 67, over 800 hospitals…

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OIG Seeks Suggestions On Safe Harbor Provisions And Special Fraud Alerts

The Office of the Inspector General (OIG) and Department of Health and Human Services (HHS) invited recommendations and proposals from the public on improving OIG Special Fraud Alerts and implementing safe harbor provisions. The latter comes under the Federal anti-kickback statute of the Social Security Act. As per the existing Health Insurance Portability and Accountability…

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Issues Arise In Processing ICD-10 Claims

The move to ICD-10 has apparently evaded most of the obstacles healthcare stakeholders predicted. Despite that, HBMA members have uncovered many challenges in the transition to the new coding system. Members of the association have encountered issues at the Medicare Administrative Contractor level, with claims having to do with National Coverage Determinations, and Local Coverage…

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GAO Report Observes Growing Trend Of Consolidation Practices Among Hospitals

The report issued by the Government Accountability Office (GAO) to the Congress turns out to be in favor of neutral payments. The report addressed the increasing trend of consolidation within the healthcare industry. There is growing number of instances where physician practices merge with other entities or hospitals purchasing physician practices. According to the report,…

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