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

Revenue Cycle Management Healthcare News

PCP Awareness of Healthcare Costs Cuts Low-Value Resource Use

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Healthcare organizations can cut down on costly low-value services, such as antibiotic prescriptions for acute sinusitis or osteoporosis screenings for young patients, by educating primary care providers about healthcare costs, a recent study...

Top 5 Facts About the Merit-Based Incentive Payment System

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In October, CMS released the final MACRA implementation rule that will put the Quality Payment Program into action on Jan. 1, 2017. Under the new value-based reimbursement program, the federal agency anticipates 592,000 to 642,000 Medicare providers...

How to Improve Healthcare Mergers and Acquisitions Strategies

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Large and mid-size healthcare organizations should implement more proactive healthcare mergers and acquisitions strategies to avoid common acquisition mistakes, such as undefined growth strategies and deal overpayments, asserted Deloitte in a...

CMS Grants $1.8B to MA Value-Based ACO Implementation Program

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The MassHealth program in Massachusetts will received about $1.8 billion over the next five years to implement value-based reimbursement structures in the statewide accountable care organization (ACO) component of the program, announced CMS....

CMS Updates Site-Neutral Payment Reform Implementation Rule

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In a recent ruling on the outpatient prospective payment system, CMS finalized several changes to the site-neutral payment reform policy under which most provider-based hospital outpatient departments will no longer receive outpatient Medicare...

Key Ways to Succeed Under MACRA’s Quality Payment Program

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Do not feel overwhelmed by the upcoming Quality Payment Program, a healthcare expert at CAPG, a non-profit trade association for accountable physician organizations, advised the projected 592,000 to 642,000 eligible clinicians participating in...

CMS Offers 66% Settlement to Reduce Medicare Appeals Backlog

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In an effort to resolve the Medicare appeals backlog, CMS recently reopened a settlement option that would allow hospitals to receive partial reimbursement for some claim denials currently stuck in the appeals process. Similar to the 2014 settlement...

FQHCs Push for Health Center Medicaid Payment Reform Models

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Federally qualified health centers (FQHCs) in five states voiced strong interest in Medicaid payment reform model participation to improve value-based care delivery and boost healthcare employment strategies, a recent Geiger Gibson RCHN Community...

Large Hospitals Fare Worse in Value-Based Reimbursement Model

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Large hospitals averaging approximately 260 staffed beds were more likely to receive a negative value-based reimbursement adjustment under a hospital-specific Medicare program in 2016, according to a recent report from Definitive Healthcare,...

90% Report Clinical Documentation Improvement Boosted Revenue

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Nearly 90 percent of hospitals with 150 or more beds and outsourced clinical documentation functions realized at least $1.5 million in appropriate healthcare revenue and claims reimbursement following clinical documentation improvement (CDI)...

CMS: Over Half in Value-Based Care Program to Earn Bonuses

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Over 1,600 hospitals in the Hospital Value-Based Purchasing Program, representing over 50 percent of total participants, will receive positive Medicare payment adjustments in 2017 for value-based care performance, CMS reported in a recent fact...

CMS Issues Final Rule on Home Health Medicare Reimbursement

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CMS recently released a final rule that will reduce Medicare reimbursement to home health providers by $130 million, or 0.7 percent, in 2017. Lower Medicare spending on home health services will stem from updates to payment rates, the Home Health...

Senate Group Drafts Chronic Disease Management Payment Reform

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The Senate Finance Committee Chronic Care Working Group recently released a draft healthcare payment reform bill targeting chronic disease management programs and services, such as the Independence at Home Model, telehealth consultations, accountable...

CMS Updates ESRD, Dialysis Medicare Reimbursement Policies

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End-stage renal disease (ESRD) and dialysis providers can expect a 0.73 percent increase in total payments compared to last year under new Medicare reimbursement rates, CMS recently announced. Medicare spending on ESRD payments is projected to...

WEDI: ICD-10 Coding Guideline Negates Some Claim Audit Policies

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A new ICD-10 coding guideline conflicts with reporting and auditing policies for several quality programs as well as medical necessity rules and other healthcare regulations, stated the Workgroup for Electronic Data Interchange (WEDI) in a recent...

How to Adopt a Retail Approach to Boost Healthcare Transparency

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More hospitals are implementing healthcare transparency strategies that borrow from the retail industry in order to retain and attract consumers, according to a recent PricewaterhouseCoopers Health Research Institute report. The report found...

GA Provider Receives Jail Time for a Healthcare Fraud Scheme

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A Georgia-area provider has recently been sentenced to three years and two months in prison stemming from a healthcare fraud case, the Department of Justice (DoJ) reported. Robert E. Windsor of Georgia was charged with fraudulent medical billing...

86% Say Provider Compensation Tied to Fee-for-Service, Salary

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About 86 percent of primary care physicians and specialists reported that their provider compensation was still primarily under fee-for-service or salary arrangements, representing a modest increase from 84 percent in 2014, according to a recent...

CMS Launches VT All-Payer Accountable Care Organization Model

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Starting in January 2017, Vermont will implement the first voluntary all-payer accountable care organization (ACO) model that will align ACO design across Medicare, Medicaid, and commercial payers, according to a recent CMS announcement. With...

Benefits, Challenges of Value-Based Health IT Implementation

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From EHR systems to mHealth apps, health IT has the potential to help providers achieve value-based care goals. But with hundreds of new technologies seemingly emerging each day, many providers are struggling to select the most appropriate health...

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