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

Affordable Care Act

New Growth in Home and Community-Based Services Spending

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) has released its “milestone” 2013 Medicaid Expenditures for Long-Term Services and Supports Report. According to the Center for Medicaid and CHIP Services (CMCS), 2013 was the...

AK Gov. Proposes Sept. Medicaid Expansion Reform Under ACA

by Jacqueline DiChiara

Medicaid expansion may be the key to cutting state spending. The governor of Alaska, Bill Walker, recently notified a state committee that he plans to accept both federal and Mental Health Trust Fund Authority money to expand Medicaid to underprivileged...

Medicare Care Choices Model Awards Drive Choice, Quality

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) is focused on helping Medicare beneficiaries, their families, and loved ones acquire the right type of healthcare. This week, CMS announced the 141 urban and rural hospices selected...

Will CMS’s Star Ratings Improve Home Health Agencies’ Quality?

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) has published the first star ratings for Home Health Agencies on Medicare.gov. As the significance of a rating system is essential to the lives of many – from considering restaurant...

Fictitious Marketplace Enrollees Get Standardized Coverage

by Jacqueline DiChiara

The federal Health Insurance Marketplace (Marketplace) desperately needs to tighten up its security measures, confirms a new report from the US Government Accountability Office (GAO). In an undercover series of 18 tests to better identify how...

Value-Based Purchasing Model Revises Home Health Payments

by Jacqueline DiChiara

In an ongoing effort to advance the quality of economically profitable healthcare, the Centers for Medicare & Medicaid Services (CMS) looks again to the promotion of care quality. CMS’s new proposal launch, authorized through the Affordable...

CMS’s Fraud Prevention System Thwarts $820M in Payment Abuse

by Jacqueline DiChiara

A 10:1 return on taxpayer money is a rare feat. Nonetheless, an advanced state-of-the-art analytics system – the Fraud Prevention System – courtesy of The Centers of Medicare & Medicaid Services (CMS) is making such a goal tangible...

Risk-Value-Based Payment Programs a Return on Investment?

by Jacqueline DiChiara

Value-based payment readiness is apparently an area of weakness for senior financial executives, reports an executive survey from the Healthcare Financial Management Association (HFMA) and Humana. An analysis of return on investment (ROI), readiness...

Reconsidering ACA Limits, Fee-for-Value as Firm Payment Fix

by Jacqueline DiChiara

As the Affordable Care Act (ACA) continues to evolve, the healthcare industry thrives on crystal ball-esque predictions about what future challenges may arise. How will the Supreme Court’s King v. Burwell decision impact premiums and the...

Aetna Acquires Humana for $37B to Moderate Healthcare Costs

by Jacqueline DiChiara

Aetna has agreed to acquire its undersized competitor, Humana Inc, for $37 billion in cash and stock. The possible unifying together of two of the nation’s largest health insurers may generate an anticipated operating revenue this year...

What is the Future of Healthcare Mergers and Acquisitions?

by Jacqueline DiChiara

As healthcare mergers and acquisitions reach a record high, will financial consequences follow? The roles of critical access hospitals (CAHs) continue to change as more are closing their doors due to financial strain. There is solid debate among...

CMS Announces HPID Final Rule Public Commentary Period

by Jacqueline DiChiara

The Department of Health and Human Services (HHS) released a Request for Information (RFI) earlier this month on the Health Plan Identifier (HPID). HPID – a standard identifier for health plans – is required to be adopted under the...

Increased Deductibles Create More Revenue Cycle Challenges

by Jacqueline DiChiara

The ability to collect payment from patients has changed dramatically with the recent proliferation of high deductible health plans (HDHPs). Increased deductibles mean more revenue cycle challenges. There has been a significant increase within...

Subsidies Upheld, State-Run Exchanges Face Funding Issues

by Jacqueline DiChiara

The King v. Burwell ruling will likely be the last major hurdle the Affordable Care Act (ACA) faces from court challenges. Says Bill Melville, Market Analyst for Decision Resources Group, to RevCycleIntelligence.com, even if subsidies are upheld...

‘Affordable’ Affordable Care Act as Sustainable Cost Model

by Jacqueline DiChiara

King v. Burwell's aftermath has been both praised as a “positive” and “disastrous” ruling as the dust continues to clear following last Thursday’s decision from the Supreme Court. Ralph S. Tyler, Partner Venable...

Burwell Addresses King v. Burwell: ‘Seize This Opportunity’

by Jacqueline DiChiara

The Affordable Care Act (ACA) is simply part of the fabric of America, says Sylvia M. Burwell, Secretary of the Department of Health and Human Services (HHS), during a White House press call mere hours after the monumental King v. Burwell decision...

Considering King v. Burwell’s Construction, Interpretation

by Jacqueline DiChiara

The aftermath of King v. Burwell is spreading like wildfire across the healthcare industry. Opinions and reactions circulate rather heavily this week – including thoughts from Sylvia M. Burwell, Secretary of the Department of Health and...

HHS Secretary Burwell Speaks on ACA, King v. Burwell

by Jacqueline DiChiara

Today’s King v. Burwell decision from the Supreme Court to uphold subsidies is a groundbreaking moment for the healthcare industry.  King v. Burwell examines whether or not those federal premium subsidies issued to residents...

Supreme Court Upholds Subsidies in King v. Burwell Decision

by Jacqueline DiChiara

The Supreme Court has ruled on King v. Burwell, a stunningly significant healthcare lawsuit intended to formally unravel various foundational components of the Affordable Care Act (ACA). The ACA has been upheld, as the Supreme Court issued...

How does the ACA Impact Providers’ Trust of Payers?

by Jacqueline DiChiara

How are those healthcare payers participating in Affordable Care Act (ACA) implementation performing? Perhaps pretty well, according to a tenth annual PayerView report card and ninth annual Payer Trust Index released consecutively by athenahealth...

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