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Hospital readmissions have long been a concern for healthcare leaders, but the latest Medicare payment adjustments are bringing renewed attention to the financial and clinical consequences of patients returning to the hospital shortly after discharge. For fiscal year (FY) 2027, the Centers for Medicare & Medicaid Services (CMS) is reducing Medicare payments to 2,334 hospitals, representing approximately 80% of hospitals evaluated under the Hospital Readmissions Reduction Program (HRRP). Of those hospitals, 244 will experience payment

The Federal Independent Dispute Resolution (IDR) process is entering a new operational phase. For health plans, providers, third-party administrators, billing organizations, and other participants, success will increasingly depend on the quality of the information exchanged before a dispute reaches arbitration. That makes Federal IDR readiness more than a legal or compliance exercise. It is also a claims-processing, data-quality, documentation, and workflow challenge. The Volume of Disputes Makes Process Quality Important Federal IDR is no longer

What is the RCD? The Review Choice Demonstration (RCD) project for Inpatient Rehabilitation Facilities (IRF) seemed like a pipe dream when the Centers for Medicare & Medicaid Services (CMS) started discussing it before the Pandemic. The goal of the RCD is to reduce the burden on providers demonstrating compliance with Medicare IRF rules.  The RCD started out slowly, but is currently in full swing in four states: Alabama (effective August 2023) Pennsylvania (effective June 2024) Texas