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ICD-10 Gap Analysis Points to Revenue Neutral Transition

The implications of ICD-10-CM/PCS for healthcare reimbursement is a topic at the top of everyone’s mind in the healthcare industry these days. As healthcare organizations continue to prepare for the transition to ICD-10-CM/PCS on October 1, 2015, an essential and important element of a successful transition is the understanding of the implications that this transition will have on reimbursement for healthcare organizations.


Most states unlikely to create insurance exchanges to save ACA subsidies

Don't count on many states to quickly establish their own insurance exchanges to keep their residents covered if the U.S. Supreme Court this month strikes down premium subsidies in states using the federal exchange.  Elected officials in most of the 34 to 37 states where subsidies are at risk don't know or won't say what they'll do if the justices eliminate the Affordable Care Act subsidies in their states, a Modern Healthcare survey of the states found. Instead, many states are playing wait-and-see, hoping Congress or the Obama administration will bail them out if thousands of residents suddenly lose affordable coverage.


CMS July 2015 Average Drug Sales Price Files Now Available

CMS has posted the July 2015 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks. All are available for download on the 2015 ASP Drug Pricing Files web page.


Medicare vies to keep ACOs on board with more flexible rules

More flexibility is coming for Medicare accountable care organizations under a final rule the CMS published Thursday (PDF). The revisions are intended to strike a balance between maintaining the program's rigor and making sure providers continue to participate. The Medicare Shared Savings Program will offer a new track to take on more financial risk of patient care, and it will allow Medicare ACOs to avoid penalties beyond the initial three-year term. The CMS will also issue future guidance on benchmarking and rebasing issues that have been sources of contention for many providers.


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