Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Revenue Cycle Management Healthcare News

AHA Calls for Value-Based Reimbursement Reform Under Trump

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In a recent letter to President-Elect Trump, the American Hospital Association (AHA) urged the upcoming administration to continue the value-based reimbursement transition by developing more effective alternative payment models, promoting telehealth,...

How Alternative Payment Models Decrease Cancer Care Costs

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As cancer care spending is expected to grow in the next four years, an oncology alternative payment model that incorporates clinical pathways and patient-centered approaches could reduce healthcare spending by 22 percent, or $9.1 million across...

How a Small Hospital Increased Patient Collections by 300%

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As patient financial responsibility continues to increase in a more consumer-focused healthcare environment, more hospitals are shifting healthcare revenue cycle management strategies to improve patient collections. Iroquois Memorial Hospital...

Staffing Shortages, Healthcare Reform Top C-Suite Concerns

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Healthcare C-suite executives identified staffing shortages and healthcare reform as having the largest impact of their organization’s ability to delivery care, a recent Premier survey found. About 41 percent of the 52 C-suite level respondents...

CMS Proposes to Limit Supplemental Medicaid Reimbursement

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CMS recently proposed a rule that would limit a state’s ability to create or increase a Medicaid reimbursement structure for hospitals, physicians, and nursing homes that pays providers for services that are not related to care delivery...

Price, Utilization Increases Upped Healthcare Spending by 4.5%

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Healthcare spending for privately insured individuals increased by 4.6 percent because of rising prices for outpatient, inpatient, and professional care services as well as prescription drugs, the Health Care Cost Institute (HCCI) recently reported....

Payment Reform Suggestions to Improve Complex Pediatric Care

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Payment reform for medically complex children is needed to support a more family- and patient-centered care delivery model that requires extensive care coordination and non-face-to-face services, a new study in Pediatrics indicated. Researchers...

AHA Urges Congress to Pass Healthcare Payment Reform Bills

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The American Hospital Association (AHA) recently called on Congress to pass several healthcare payment reform bills, such as the Helping Hospitals Improve Patient Care Act and the Sustaining Healthcare Integrity and Fair Treatment Act of 2016,...

Do Hospital Mergers Disincentivize Orgs to Lower Their Costs?

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While hospital mergers and acquisitions increase a healthcare system’s market power to negotiate higher private payer claims reimbursement rates, consolidation may also disincentivize hospitals to lower their healthcare costs, a recent...

OIG Identifies Top HHS Financial, Medicare Fraud Challenges

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The Office of the Inspector General (OIG) recently found the most significant management and performance challenges facing the Department of Health and Human Services (HHS), including financial management and Medicare fraud prevention inefficiencies....

Tips for Negotiating Claims Reimbursement Rates with Payers

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Every dollar counts in the healthcare revenue cycle, especially with declining Medicare reimbursement rates and new value-based care models. But organizations should understand how to successfully negotiate claims reimbursement contracts with...

Premier Medicare ACOs Outperform Peers in Cost, Quality By 2:1

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Medicare accountable care organizations (ACOs) that are part of Premier Inc.’s Population Health Management Collaborative (PHMC) outperformed other Medicare Shared Savings Program (MSSP) and Pioneer ACOs in earning shared savings and improving...

Using an Alternative Payment Model to Reduce Hospitalizations

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Are clinical interventions enough to alter provider behavior to align with value-based care? Or are providers more motivated to change because of financial incentives under alternative payment models? CMS recently partnered with the University...

CMS Reduces Inpatient Medicare Improper Payment Rate by 58%

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In a recent official blog post, CMS touted that the Medicare improper payment rate for inpatient hospital claims fell by 58.3 percent between 2014 and 2016. While Medicare inpatient hospital claims accounted for $10.45 billion in improper payments...

AMA Backs Team-Based Care Delivery, Value-Based Drug Pricing

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The American Medical Association (AMA) recently released updated organization-wide ethical guidelines that detailed how organizations can lower healthcare costs using team-based care delivery as well as how the industry can implement value-based...

How to Develop a Value-Based Care Implementation Strategy

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When building a value-based care strategy, healthcare organizations should focus on improving care delivery across skilled nursing facilities, at-home services, and end-of-life services, Steven Strongwater, MD, President and CEO of Atrius Health,...

Potential Challenges, Benefits of the Cardiac Bundled Payment

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Earlier this year, CMS proposed a cardiac bundled payment model that would reduce Medicare spending by $170 million on five years, but a new report in the Journal of the American Medical Association identified several potential drawbacks of the...

Health Centers Face Post-ACA Revenue Cycle Management Issues

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Although the Affordable Care Act provided temporary funding to federally qualified health centers, a new study from the UCLA Center for Health Policy Research showed that community health centers will still need funding to resolve healthcare...

Only 23% Have Consumer-Centered Healthcare Capabilities

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While approximately two-thirds of healthcare leaders view consumer-centered healthcare as a priority, especially in light of value-based reimbursement, only 23 percent stated that their organization had the capabilities to develop consumer insights,...

Does Higher Hospital Profitability Drive Up Healthcare Costs?

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The push to maximize hospital profitability across for- and non-profit organizations is driving up healthcare costs, contends a new commentary in The American Journal of Medicine. Hospitals are focusing on boosting profitability rather than reducing...

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