Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid
  • Cerner to Increase Focus on Value-Based Reimbursement

    July 19, 2016 - Cerner has named Adventist Health System's Jeff Hurst to oversee its revenue cycle management division, the company announced Tuesday. Hurst, who currently serves as Florida Hospital's Senior Vice President of Finance at Florida Hospital will depart the health system after 20 years of service and take up his new role as Cerner's Senior Vice President of Revenue Cycle Management...

  • The Future of Accountable Care Organizations Involves Risk

    July 11, 2016 - As many healthcare providers know, participating in a value-based care program, such as an accountable care organization, is about more than just tying payment to quality.  It involves shouldering financial risk as a way to motivate clinicians to make better choices and promote accountability for their services.  However, many healthcare organizations have shied away from accepting...

  • 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...


Today's Top Stories

CMS Details Rationale Behind Hospital Quality Ratings

Just as consumers rate restaurants on Yelp.com on a scale of one to five stars, CMS has published star ratings for healthcare facilities on its Hospital Compare website to boost healthcare transparency. According to CMS leadership, the federal...

Healthcare Transparency Bill Proposes to Delay Star Ratings

Two House Representatives, Jim Renacci (R-OH) and Kathleen Rice (D-NY), have recently introduced a healthcare transparency bill that would require CMS to delay the release of new hospital star ratings for another year to ensure that the program’s...

New Rules for Bundled Payment Models for Cardiac, Hip Care

CMS has proposed to develop bundled payment models for cardiac care and hip surgeries that would qualify for financial incentives in the proposed Quality Payment Program in MACRA, according to a recent announcement. “On July 25, 2016, the...

DOJ Charges 3 Individuals in $1B Medicare Fraud Scheme

Healthcare fraud, waste, and abuse is known to drain the industry of essential funds, but three individuals have allegedly participated in Medicare fraud and money laundering schemes that have cost the program more than $1 billion. According...

Examining the Role of Financial Risk in Value-Based Care

As the healthcare industry ramps up its efforts to advance value-based care, providers are expected to take on more financial risk. One of the goals of value-based care is to transition financial risk away from taxpayers and healthcare payers...

Non-ACO Hospitals Outperform ACOs in Value-Based Care Programs

To usher in the age of value-based care, CMS has implemented several value-based care programs and introduced various alternative payment models, such as accountable care organizations (ACO). These programs all have a common goal: raise care...

Healthcare Costs Concerns Impact Provider Rationing Behavior

It is not uncommon to hear patients say that healthcare costs are going up, especially as more individuals enroll in high-deductible health plans. But, some providers oftentimes question if they should be responsible for helping to control costs....

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