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

Revenue Cycle Management Healthcare News

More Primary Care Leads to Less End-of-Life Medicare Spending

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Regions with more primary care providers saw less Medicare spending on end-of-life care compared to areas with less primary care practices, a recent Annals of Family Medicine study found. Medicare spending during the last two years of life was...

Avoidable Hospitalizations Drop 31% for Long-Term Care Patients

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Avoidable hospitalizations among dual-eligible long-term care facility residents dropped by 31 percent between 2010 and 2015 largely because of value-based care programs, CMS recently stated in an official blog post. “Family members want...

CMS: Providers Need Data Access for Value-Based Reimbursement

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Value-based reimbursement success rests on providing clinicians with convenient and increased access to meaningful data, the leaders of the Office of the National Coordinator (ONC) and CMS stated in a recent official CMS blog post. “Data...

HHS Finalizes Solutions to Decrease Medicare Appeals Backlog

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In effort to reduce the significant Medicare appeals backlog, the Department of Health and Human Services (HHS) recently finalized several appeals process changes. Major modifications included using precedential decision-making at the Departmental...

AAFP: Primary Care Undervalued in Medicare Reimbursement

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CMS released updated physician fee schedule rates in November 2016, but the American Academy of Family Physicians (AAFP) recently contended that Medicare reimbursement rates for primary care providers are still lacking. In a letter to CMS, the...

All-Payer Alternative Payment Model Targets PA Rural Hospitals

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A new six-year all-payer alternative payment model will focus on improving care quality and reducing healthcare costs at rural hospitals in Pennsylvania, CMS announced in a recent fact sheet. The CMS Innovation Center’s latest project,...

CMS Brings Integrated, Multi-Payer Claims Data Access to CPC+

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In an official blog post, CMS recently touted its success with improving primary care provider productivity by giving practices in the Comprehensive Primary Care (CPC) program more multi-payer claims data access. The Medicare primary care program...

Electronic Claims Management Adoption to Save Providers $7.9B

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Healthcare providers could save about $7.9 billion annually by switching to automated claims management processes, particularly for prior authorizations, remittance advices, and claim attachment submissions, according to the 2016 CAQH Index....

Do Pay-for-Performance Programs Improve Patient Outcomes?

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Value-based reimbursement models that pay for performance modestly incentivized providers to stick to clinical guidelines, but they may not be linked to better patient outcomes, a recent Annals of Internal Medicine study indicates. The literature...

Addressing Social Risk in Medicare Value-Based Reimbursement

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Hospitals that disproportionately treat patients with social risk factors, such as low income and race, may be unfairly penalized under some Medicare value-based reimbursement programs. But the National Academies of Science, Engineering, and...

CMS Releases MSSP Track 1+ Model Risk Structures, Eligibility

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In a new Medicare Shared Savings Program (MSSP) Track 1+ fact sheet, CMS clarified model details for 2018 to 2020 participation, including maximum shared savings and losses rates, risk assignments, and eligibility requirements. CMS announced...

NAACOS Reveals 2017 Accountable Care Organization Priorities

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As part of its 2017 advocacy agenda, the National Association of Accountable Care Organizations (NAACOS) released policy recommendations for ACO improvement. The recommendations included Medicare Shared Savings Program (MSSP) changes, one-sided...

AHA Calls for Medicare Reimbursement Bump for Hospital Services

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The American Hospital Association (AHA) recently urged the Medicare Payment Advisory Commission (MedPAC) to finalize a recommendation that would boost Medicare reimbursement for hospital inpatient and outpatient services in 2018. In a comment...

ACO Incentives, Coordination Improve Complex Pediatric Care

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Children with medical complexities, or children who require the highest level of service and support, are one of the most expensive pediatric patient populations. But provider collaboration and financial incentives through an accountable care...

Medicare Spending on Drug Coverage Tripled from 2010 to 2015

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Medicare spending on prescription drugs under the Part D catastrophic coverage program more than tripled from 2010 to 2015, increasing from $10.8 billion to $33.2 billion, the Office of the Inspector General (OIG) recently reported. The significant...

Drug Costs, Limited Claims Reimbursement Challenge Cancer Care

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Cancer care centers named high prescription drug costs and lack of claims reimbursement for supportive services as the top challenges associated with providing care in 2016, according to an annual Association of Cancer Care Centers (ACCC) survey....

Court Denies HHS Wish to Nix Medicare Appeals Backlog Timeline

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A federal court recently denied a Department of Health and Human Services (HHS) request to reconsider the four-year timeline developed to eliminate the Medicare appeals backlog at the administrative law judge level. HHS projected the backlog...

CMS: Innovation Center Key to APM, MACRA Implementation Success

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In a recent official blog post, CMS Acting Principal Deputy Administrator Patrick Conway, MD, highlighted the federal agency’s Innovation Center’s successes with alternative payment model development, especially as MACRA implementation...

HRSA Adds $5K Fines for 340B Prescription Drug Rate Overcharging

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Drug manufacturers participating in the 340B Drug Pricing Program who intentionally charge hospitals prescription drug rates higher than established ceiling prices will face a $5,000 penalty per instance, a new Health Resources and Services Administration...

How the 21st Century Cures Act Impacts Medicare Reimbursement

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The 21st Century Cures Act may have been a landmark law for precision medicine, drug innovation, telemedicine, and mental health reform, but the law also contained several Medicare reimbursement policy changes set to take effect starting this...

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