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CMS’s Hospital Readmissions Reduction Program May Not Be Used to Deny Individual Commercial Claims

The Hospital Readmissions Reduction Program (HRRP) is a Medicare value-based purchasing program that reduces payments to hospitals with excess readmissions. This performance program penalizes hospitals up to three percent of...more

Suspension of the 2% Sequestration Reduction May Affect Commercial Payer Reimbursement

Section 4408 of the CARES Act suspends the 2% sequestration reduction to payments under the Medicare program that have been in place since April 1, 2013. The suspension of sequestration in Medicare will run from May 1, 2020...more

How Payers Are Improperly Underpaying Inpatient Services As Observation Services

Health plans and their delegated IPAs are using a number of different tactics to deny payment for inpatient services by improperly classifying inpatient claims as observation or other types of outpatient status. Payers are...more

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