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

Revenue Cycle Management Healthcare News

GA Dentist Sentenced to Prison for $1M Medicaid Fraud Scheme

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A dentist from Georgia faces one and a half years in federal prison after she reportedly participated in a Medicaid fraud scheme totaling almost $1 million, the Department of Justice (DoJ) recently announced. From 2009 to 2013, Oluwatoyin Solarin,...

Healthcare C-Suite, Earned Incentive Compensation Down in 2016

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Median healthcare CEO compensation in terms of total cash value remained relatively the same for non-physician executives in 2016, while physician CEOs faced a 3.9 percent reduction, a recent AMGA Consulting survey found. The survey of 78 medical...

78% of Hospital Staff Still Face Manual Supply Chain Management

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Hospitals may not be operating with the most efficient healthcare supply chain management tools, a recent Cardinal Health and SERMO survey found. Only 17 percent of hospital staff reported that their facility installed an automated inventory...

Coalition Offers CMMI, Alternative Payment Model Improvements

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Thirty-five healthcare industry groups recently banded together to offer the newly-approved Department of Health and Human Services (HHS) Secretary a set of guidelines for CMS Innovation Center (CMMI) and alternative payment model development...

FFS, Risk-Based Medicaid ACO Programs Similarly Reduce Costs

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In a comparison of two state Medicaid Accountable Care Organization (ACO) programs, researchers in a JAMA Internal Medicine study found that Oregon’s global capitation ACO model produced similar healthcare savings and care quality improvements...

MGMA to Price: Simplify MACRA, Reassess Alternative Payment Models

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MGMA would like HHS Secretary Tom Price to reduce the regulatory burdens of HIPAA and MACRA, reassess the development of Alternative Payment Models (APMs), and postpone implementation of the ONC’s 2015 Certified EHR criteria, the organization...

One-Third of Healthcare Execs Ready for MACRA Implementation

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Only 35 percent of healthcare executives said that their organization has a MACRA implementation strategy and feels prepared for the new value-based reimbursement program, according to a recent Health Catalyst and peer60 survey. The survey of...

2012 MSSP ACOs Decreased Post-Acute Care Spending by 9%

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A new JAMA Internal Medicine study showed that Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) established in 2012 decreased post-acute care spending by a 9 percent differential reduction by 2014 without compromising...

Asthma Education Model Lowers Resource Use, Healthcare Costs

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Asthma education programs can help providers to significantly reduce unnecessary resource use and healthcare costs by boosting patient knowledge about chronic disease management, a recent American Journal of Managed Care study stated. About 12...

Stakeholders Propose 4 MACRA Physician-Focused Payment Models

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MACRA’s Quality Payment Program offers 5 percent maximum incentive payments if eligible clinicians sufficiently participate in an Advanced Alternative Payment Model (APM) from 2017 to 2022. But many specialists are still waiting for CMS...

MACRA Implementation, Healthcare Consumerism Trends at HIMSS17

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As healthcare stakeholders are packing their bags for the upcoming HIMSS17 conference in sunny Florida, many are expecting to learn about the hottest healthcare revenue cycle management topics from the past year. From MACRA implementation and...

52-47 Senate Vote Confirms Tom Price as New HHS Secretary

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Early this morning, the Senate approved Tom Price as the new Department of Health and Human Services (HHS) Secretary by a 52 to 47 vote, according to multiple sources. Price, a Republican representative from Georgia, will be the first provider...

HHS: Physician Self-Referral Law Hinders Value-Based Care

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Some healthcare fraud prevention regulations many impede value-based care models that use financial incentives to encourage providers to improve care quality and reduce healthcare costs, the Department of Health and Human Services (HHS) recently...

NY Clinic Manager Pleads Guilty in $70M Medicare Fraud Scheme

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A New York-based healthcare clinic manager recently pled guilty for his role in a Medicaid and Medicare fraud ring involving three clinics across New York City. The scheme to defraud federal healthcare programs resulted in $70 million in fraudulent...

AMA: Eliminate Prior Authorization for Opioid Abuse Treatment

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The American Medical Association (AMA) recently called on attorney generals across the nation to follow in New York’s footsteps with reforming prior authorization requirements for medication-assisted treatment for opioid abuse. New York’s...

Key Considerations for Bundled Payment Model Adoption, Success

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As the value-based reimbursement transition pushes on, many provider organizations have turned to bundled payment models as a stepping stone to alternative payment model adoption. “Bundled payments can be an organization’s first step...

Did Risk-Based APMs Propel Greater Provider Consolidation?

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A recent Health Affairs study revealed that risk-based alternative payment models, such as accountable care organizations (ACOs), have not spurred greater provider consolidation in the post-Affordable Care Act healthcare environment. Medicare...

How Radiologists Can Join an Advanced Alternative Payment Model

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Radiologists may want to look to the physician-focused payment model path in MACRA to develop specialty-specific Advanced Alternative Payment Models (APM), suggested a recent Journal of the American College of Radiology report. Harvey L. Neiman...

Hospital Costs Fall Despite Overall Healthcare Spending Growth

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Medicare spending growth on both inpatient and outpatient services hit an all-time low for the first time in 17 years, with inpatient hospital costs notably decreasing by 1.9 percent since 2015, the American Hospital Association (AHA) recently...

AMGA: Slow Encounter Data Transition in Medicare Reimbursement

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The American Medical Group Association (AMGA) recently commended CMS for decelerating the transition to using encounter data as a means for risk-adjusting Medicare reimbursement to Medicare Advantage organizations in 2018. In an announcement...

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