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

Revenue Cycle Management Healthcare News

Do Medicaid Reimbursement, Admissions Produce Hospital Profit?

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Do Medicaid reimbursement rates and federal uncompensated care payments really cover the healthcare costs of treating larger proportions of Medicaid beneficiaries and uninsured individuals? Two new studies in Health Affairs indicate yes, but...

NY Senator Challenges Rural Medicare Reimbursement Repayment

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New York Senator Charles Schumer (D-NY) recently spoke out against a CMS plan to recoup supplemental Medicare reimbursement to rural hospitals that could cause hospitals in New York alone to repay the federal agency $15 to $20 million for payments...

Value-Based Care, Price Transparency Drive Hospital Mergers

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Healthcare system and hospital mergers will likely increase as new value-based care models emerge, according to a recent Healthcare Financial Management Association (HFMA) report. But the rise in value-based reimbursement and price transparency...

Providers Skip Healthcare Costs Talk with 68% of Cancer Patients

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As providers face increased patient financial responsibility, healthcare costs discussions with patients are becoming more important for obtaining full payment. But a new study from the Cancer Support Community showed that many providers are...

Slavitt Offers Value-Based Care Steps Post MACRA Implementation

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As CMS gets ready for MACRA implementation in the new year, CMS Acting Administrator Andy Slavitt urged healthcare and political leaders to carry on value-based care progress made under the Affordable Care Act. In a statement at the MACRA MIPS/APM...

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...

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