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

Revenue Cycle Management Healthcare News

Using Bundled Payments to Pay Providers for mHealth Nudges

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Many providers have been able to extend their reach outside of their office by using mHealth technologies that encourage patients to improve their own health outcomes through nudges. However, payment structures for the healthcare encounters have...

Top 5 Ingredients of a Successful Alternative Payment Model

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Alternative payment models tie provider reimbursement to quality and cost performance. Besides their foundational function, though, each model has its own rules pertaining to financial incentive structures, quality measurements, and patient populations...

Top 4 Claims Denial Management Challenges Impacting Revenue

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For most healthcare organizations, claim denials are a normal, if not a frequent, occurrence. While very few can boast that their denial rates are close to zero, many providers face a number of challenges with implementing an effective claims...

46% of Providers Unsure About Value-Based Purchasing Impact

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Value-based purchasing is not a new term for many providers, yet 46.4 percent of healthcare providers and leaders are still unsure how the shift away from fee-for-service payments will impact their revenue cycles, a recent Physicians Practice...

Health IT, Care Navigators Most Effective at Lowering Costs

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While countless strategies are out there for making care delivery more efficient, a recent Health Affairs study revealed that interventions that use health IT and community health workers realized the greatest cost savings. Researchers examined...

Higher Hospital Costs Stem from ICU Overuse for Some Conditions

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Healthcare providers may be able to decrease hospital costs by avoiding ICU admissions for some patients with chronic obstructive pulmonary disease (COPD), exacerbation of heart failure (HF), and acute myocardial infarction (AMI), a recent American...

274 Orgs Calls on CMS to Add Medicare Advantage Advanced APMs

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CMS should develop financial incentives comparable to those in the Quality Payment Program’s Advanced Alternative Payment Model (APM) track for providers who assume financial risk under Medicare Advantage plans, CAPG and 273 other healthcare...

NH Judge Rejects CMS FAQs Clarifying Medicaid DSH Payments

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A district court in New Hampshire recently prohibited CMS from enforcing two Frequently Asked Questions (FAQs) that clarified how private payer and Medicare reimbursements paid to hospitals for dually-eligible Medicaid patients would be used...

AMGA Backs CMS Proposal to Limit 2018 Medicare Encounter Data

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The American Medical Group Association (AMGA) recently supported a CMS proposal to delay the increased use of encounter data to determine Medicare Advantage plan risk scores and claims reimbursement amounts. In a recent proposed rule, CMS stated...

Premier: Bundled Payment Models Should be Voluntary Nationwide

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Premier Healthcare Alliance recently offered CMS several recommendations for bundled payment model development, including making programs voluntary for providers across the nation. CMS has implemented several mandatory bundled payment models...

CMS Reopens Next Generation ACO Application Request Portal

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Providers interested in joining the Next Generation Accountable Care Organization (ACO) model in 2018 can now access the Request for Applications and Letter of Intent on the program’s portal, according to a recent CMS announcement. The...

FFS Compensation Linked to More Stroke Prevention Surgeries

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A new study in JAMA Surgery found that providers with fee-for-service compensation performed more carotid stenosis interventions on symptomatic and asymptomatic patients compared to providers reimbursed by a salary. Using data from the Military...

65% of Organized Providers Paid Via Alternative Payment Models

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Nearly two-thirds of healthcare providers in some type of integrated employment model, such as integrated health networks, physical hospital organizations, accountable care organizations, and large medical groups, are primarily reimbursed through...

AHA Critiques MedPAC’s Potential MACRA Implementation Changes

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The American Hospital Association (AHA) recently responded to potential MACRA implementation changes discussed at the Medicare Payment Advisory Commission’s (MedPAC) January meeting. The industry group called on MedPAC to “draw upon...

Exploring MIPS Advancing Care Info, Improvement Activities

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At HIMSS17, CMS leaders took the stage to ease provider concerns about the newly launched Quality Payment Program and its more popular value-based reimbursement track, the Merit-Based Incentive Payment System (MIPS). Following up on their MIPS...

CMS Calls on Stakeholders for Pediatric APM Development Input

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CMS recently put out a request for information for a potential Medicaid and Children’s Health Insurance Program (CHIP) alternative payment model targeting pediatric care, according to an official CMS blog post. “Through the RFI [request...

Transradial, Same Day Discharge Cardiac Care Drops Costs by $3.7K

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From acute myocardial infarctions to coronary artery bypass grafts initiatives, recent Medicare bundled payment models have providers focusing more on reducing healthcare costs and improving care quality for a range of cardiac care episodes....

Preparing Providers for the Healthcare Consumerism Shift

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With a couple of swipes and clicks, patients are driving the shift to healthcare consumerism in the palm of their hands. But many healthcare organizations are not finding it as easy to align their care delivery and patient collection strategies...

Understanding 2017 MIPS Quality, Cost Performance Categories

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CMS leaders at HIMSS17 were not shy with telling session attendees that they are currently in the first Quality Payment Program performance year. To help providers better understand the program, which launched on Jan. 1, the federal agency’s...

Provider Profitability Tops Healthcare Revenue Cycle Concerns

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One of the top healthcare revenue cycle concerns with 40 percent of providers is maintaining profitability while remaining independent, a recent RemitDATA survey revealed. The survey of healthcare providers, billing companies, and vendors showed...

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