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

Revenue Cycle Management Healthcare News

Former Tenet Exec Charged in $400M Healthcare Fraud Scheme

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The Department of Justice (DoJ) recently announced the indictment of Tenet Healthcare Corporation’s former senior vice president of operations for his alleged participation in a healthcare fraud scheme totaling over $400 million in inappropriate...

Healthcare Execs Ponder Financial Impact of Possible ACA Repeal

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With a possible full or partial Affordable Care Act repeal in the near future, healthcare executives called for some of the healthcare reform law’s provisions to continue, such as increased insurance coverage and the value-based reimbursement...

Maryland All-Payer APM Reduces Medicare Hospital Costs by $429M

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As the Maryland All-Payer alternative payment model starts its fourth year, a Health Affairs report shows that the program reduced Medicare hospital costs by $429 million, exceeding CMS requirements that the model save $330 million five years....

4 Key Ways to Boost Point-of-Service Patient Collections

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In a time of healthcare consumerism and high-deductible health plans, the patient has become a major revenue source for healthcare organizations. But without strong point-of-service patient collection strategies, providers could be seeing their...

GAO Finds $36B in Improper Medicaid Reimbursements in 2016

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Approximately $36 billion in Medicaid reimbursements made to providers and suppliers in 2016 were improper, a 9.8 percent increase from last year’s Medicaid improper payment amount, the Government Accountability Office (GAO) recently reported...

Group Purchasing Reduces Healthcare Supply Chain Costs Up to 15%

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In the first Annual Value Report, the Healthcare Supply Chain Association (HSCA) found that group purchasing organizations reduced healthcare supply chain costs by 10 to 15 percent for providers. Prescription drug spending also went down by up...

Beth Israel, Lahey Health Move Forward with Healthcare Merger

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Massachusetts-based Beth Israel Deaconess Medical Center and Lahey Health announced plans to pursue a healthcare merger earlier this week. The two healthcare systems have debated a potential merger since 2011, but the recent letter of intent...

More Orgs Transitioning to Full Physician-Hospital Integration

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The proportion of healthcare organizations that have full physician-hospital integration with physicians on salary grew from 44 percent in 2008 to 55 percent in 2013, a new Rice University’s Baker Institute for Public Policy report found....

Hospitals, Health Systems Eye Financial Snags in ACA Repeal

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In identical letters to the Trump Administration and Congress, the American Hospital Association and other state and regional associations are urging members of both branches of the federal government to continue working on legislation to...

Patient Care Navigation Program Reduces Cancer Care Costs

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Using non-physician and nurse providers as part of a patient navigation program can significantly lower healthcare costs and utilization for cancer patients while generating a return on investment, a recent JAMA Oncology study revealed. From...

Predictive Analytics Top Healthcare Supply Chain Priorities

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Provider organizations ranked predictive analytics as the biggest healthcare supply chain opportunity in 2017, a recent Global Healthcare Exchange, LLC (GHX) survey revealed. The survey of 50 healthcare organizations with the most automated healthcare...

How Do Hospital Mergers Lower Costs, Drive Quality Improvement?

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Recent hospital mergers and acquisitions led to significant healthcare costs savings without sacrificing care quality and affordable prices, a recent Charles River Associates and American Hospital Association (AHA) report indicated. Based on...

Industry Orgs Urge Lawmakers to Continue Value-Based Care Push

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Over 120 healthcare industry groups, including hospitals, healthcare systems, payers, and professional organizations, recently urged the Trump administration and Congress to not discontinue or slow the transition to value-based care. In the letter...

Healthcare Groups Offer 21 Prior Authorization Improvements

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A coalition of 17 healthcare industry groups recently called on health plans, benefit managers, and other healthcare stakeholders to change prior authorization requirements to improve care continuity, reduce provider burdens, and improve timely...

How a Rural Hospital Used Health IT, EHR to Stay Independent

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In a time of declining claims reimbursement rates and value-based care, rural hospitals are struggling more than ever to improve their healthcare revenue cycle management strategies. For many rural hospitals, the decision oftentimes comes down...

Should the Hospital Readmissions Reduction Program Add Sepsis?

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The Medicare Hospital Readmission Reduction Program currently determines value-based penalties on 30-day unplanned readmissions rates for six conditions. But the value-based reimbursement program may be missing a key condition that contributes...

CMS Reopens 2018 Next Generation ACO Model Applications

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Providers interested in participating in the Next Generation Accountable Care Organization (ACO) model in 2018 can now submit a letter of intent to CMS, according to the alternative payment model’s webpage. The Next Generation ACO model...

Executive Order Calls for ACA Financial, Marketplace Flexibility

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Just hours after taking office, President Trump signed a broad executive order that intends to minimize the “economic burden of the Patient Protection and Affordable Care Act” before an official repeal of the law. Under the executive...

HHS, DoJ Recovered $3.3B From Healthcare Fraud Cases in 2016

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Through healthcare fraud cases and settlements in 2016, Department of Health and Human Services (HHS) and Department of Justice (DoJ) initiatives returned over $3.3 billion to the federal government and individuals, including $1.7 billion to...

359K Clinicians to Join CMS Alternative Payment Models in 2017

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CMS recently announced that the federal agency selected over 359,000 clinicians to participate in four of the federal agency’s alternative payment models in 2017. The new participants will be joining the Medicare Shared Savings Program...

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