Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid
  • Turnkey Approach to Fighting Healthcare Fraud, Waste, Abuse

    June 6, 2016 - Healthcare fraud, waste, and abuse (FWA) investigators have a tough job. Keeping pace with the latest schemes, continuously weeding through hundreds of false-positive leads, and understanding the right time to pursue a case are just a few of the challenges a health plan’s special investigative unit (SIU) face. When armed with the right information to immediately open a solid case, SIUs...

  • 8 Tips for Avoiding Denials, Improving Claims Reimbursement

    June 2, 2016 - If your practice is like most, your billing staff sees the words “CLAIM DENIED” fairly often, which not only leads to frustration and increased work but also reduced revenue for the practice over time. A recent study by the American Medical Association found that medical practices spend almost $15,000 on the phone calls, investigative work, and claims appeals associated with reworking...

  • 5 Ways to Cut Costs through Hospital Revenue Cycle Management

    May 16, 2016 - As healthcare costs continue to rise, hospital revenue cycle management has become an important focal point for providers. Healthcare expenditures in the US are projected to reach $4.4 trillion by 2018, according to an article in The American Journal of Clinical Pathology. This would amount to 20.3 percent of projected gross domestic product. It can be tricky for hospitals to maximize cash...

  • 5 Most Common Hospital Revenue Cycle Management Challenges

    May 4, 2016 - Since the Affordable Care Act, the task of hospital revenue cycle management has changed significantly. Between ICD-10, MACRA, and accountable care, it has become a hospital’s best interest to have an effective revenue cycle management system in place so they can handle the financial pressures that come from regulation. Overall, the healthcare revenue cycle is dynamic and continues to...


Today's Top Stories

CMS Releases Medicare Reimbursement Schedule for DMEPOS Items

The Centers for Medicare & Medicaid Services (CMS) has released an updated fee schedule for Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), which adjusts Medicare reimbursements to suppliers based on competitive...

HHS, DoJ Announce Largest Healthcare Fraud Takedown

The Department of Health and Human Services (HHS) has recently partnered with the Department of Justice (DoJ) to charge 301 individuals, including 61 physicians and licensed medical professionals, with reportedly participating in healthcare fraud...

Characteristics of Successful Accountable Care Organizations

As the number of accountable care organizations (ACO) continues to grow, many healthcare providers are all too familiar with the alternative payment model’s overarching goals of improving care quality, advancing population health, and reducing...

CMS Proposes Revisions to Medicaid Improper Payment Programs

The Centers for Medicare and Medicaid Services (CMS) is calling on healthcare stakeholders to comment on a proposed rule that would change how states identify improper payments stemming from Medicaid and Children’s Health Insurance Program...

AHA Seeks Changes to Post-Acute Care Medicare Reimbursement

The American Hospital Association (AHA) has called on the Centers of Medicare and Medicaid Services (CMS) to revise proposed Medicare reimbursement reforms for two post-acute care models. In separate letters, the AHA outlined several issues with...

Uncompensated Care Drops by $6B after Medicaid Expansion

Numerous individuals seek necessary medical services at hospitals regardless the ability to pay, but uncompensated care costs from charity cares and patient debt can strain hospital revenue cycles. However, as states develop Medicaid expansion...

Risk-Based Alternative Payment Models Key to Value-Based Care

Although the Department of Health & Human Services (HHS) recently announced that it had already tied 30 percent of Medicare payments to an alternative payment model nearly a year ahead of schedule, a recent study indicates that further value-based...

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