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

Affordable Care Act

CMS’ Open Payments Advance Revenue Cycle Transparency

by Jacqueline DiChiara

Physicians and teaching hospitals across the healthcare spectrum will be buried in a numbers game come April 6, 2015 when The Centers for Medicare & Medicaid Services’ (CMS’) period of payment review for physicians begins. Open...

Does ACA Boost Physicians’ Medicaid Participation?

by Jacqueline DiChiara

Medicaid beneficiaries are keeping the doctor away. Newly released data may offer a fresh industry-wide perspective about how often physicians accept Medicaid regarding delayed implementation stemming from the Affordable Care Act’s (ACA’s)...

Medicaid Providers Struggling to Raise Reimbursement Rates

by Jacqueline DiChiara

Medicaid providers seeking to raise their reimbursement rates by suing the government are essentially out of luck, according to documentation within a recent Supreme Court ruling. “The notion that respondents have a right to sue,”...

Has the Affordable Care Act Led to a Slowdown in Premiums?

by Jacqueline DiChiara

Slow and steady appears to be the financial mantra echoing forth within the healthcare industry. There has been a distinct deceleration in premium growth within the past three years following the implementation of Affordable Care Act...

Will Cost Shifting Drive Support for Larger Public Payments?

by Jacqueline DiChiara

Speculation abounds around whether hospitals’ decisions to increase the prices charged to commercially insured individuals to compensate for decreased Medicare reimbursement via cost shifting will reduce the healthcare industry’s...

Why Is Medicaid Expansion a Win for Healthcare Providers?

by Jacqueline DiChiara

As anyone standing before a plate of freshly baked desserts or fearfully opening a credit card bill post online shopping binge can attest, the art of equilibrium is essential. This idea of balance is also needed within the financial realm of...

Quantify Denial Rates for Smooth Revenue Cycle Management

by Jacqueline DiChiara

A hospital or medical practice’s ability to swiftly and economically process claims and quantify denial rates is critical to ensure smooth revenue cycle management and medical reimbursement. The ability to accurately predict reimbursement...

HHS Launches Health Care Payment Learning and Action Network

by Jacqueline DiChiara

The Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell met with President Obama to launch the Health Care Payment Learning and Action Network. An estimated 2800 payers, providers, employers, patients, states, consumer groups,...

Affordable Care Act Means Lower Reimbursement for Physicians

by Jacqueline DiChiara

One year after The Affordable Care Act’s (ACA) implementation, most physicians urge Congress to overturn the legislation after experiencing lower reimbursement, as reported in a recent physician survey. Although 44 percent of surveyed physicians...

Adapting the Healthcare Revenue Cycle to Changing Regulation

by Jacqueline DiChiara

Providers continue to evaluate healthcare revenue cycle and volume in relation to the Affordable Care Act (ACA). ACA’s underlying elements — Medicaid expansion and reform — are under close examination. Derek Bang, CPA, CGMA,...

The Difficulty in Quantifying Improper Medicaid Payments

by Jacqueline DiChiara

Recently, the Government Accountability Office (GAO) recommended that state Medicaid agencies should mandatorily quantify improper Medicaid payments and inform the effectiveness of their electronic payment-integrity tools to the federal...

Medicaid Acceptance, Payment Rates Both on the Decline

by Jacqueline DiChiara

The issue of a widespread lack of Medicaid acceptance is ongoing and yet to be resolved. A short-lived increase in Medicaid payments to primary care physicians last year has not generated an increase in Medicaid acceptance. More intervention...

King v. Burwell Opposition Means 9.3 Million Lose Subsidies

by Jacqueline DiChiara

The King v. Burwell case will be formerly addressed within the US Supreme Court on March 4, 2015. The Supreme Court will hear arguments regarding the Affordable Care Act’s (ACA) future implications and if the Internal Revenue Service will extend...

$200K in Funding for Mich. Medicaid Beneficiary Care Access

by Jacqueline DiChiara

On February 23, The Blue Cross Blue Shield of Michigan (BCBSM) Foundation and Blue Cross Blue Shield of Michigan announced $200,000 in a handful of grants for Medicaid Beneficiary care access. Grants will assist with funding for Michigan’s...

Looking Back on 50 Years of Medicare and Medicaid

by Stephanie Reardon

The Medicare and Medicaid system has evolved along with the healthcare industry. It was a warm day on July 30, 1965 in Washington, D.C. when President Lyndon B. Johnson signed the Social Security Amendments bill into law. This would establish...

Indiana Implements ACA Medicaid Expansion

by Stephanie Reardon

Starting February 1, 2015, eligible beneficiaries will have access to affordable high-quality healthcare coverage . Indiana has become the 28th state (including DC)  to expand its Medicaid program under the Affordable Care Act (ACA), according...

Medicare and Medicaid Cuts One of Many Revenue Problems

by Stephanie Reardon

Medicare and Medicaid pay less for services rendered than private insurance. The Medicaid “fee bump” instated by the Affordable Care Act (ACA) temporarily increased the reimbursement rates for doctors who accepted Medicaid patients....

Can Increased Medicaid Reimbursements Improve Appointment Availability?

by Stephanie Reardon

Study determined Medicaid appointment availability directly correlated to the size of the Medicaid reimbursement increase implemented by the ACA. The Affordable Care Act (ACA) allows many previously uninsured individuals to get affordable...

High Deductibles Hurt Patient Pay Collections

by Stephanie Reardon

From 2003 to 2014, insurance premiums increased in every state in the country approximately three times more quickly than median household incomes. A brief published by the Commonwealth Fund, a foundation  aimed at improving the healthcare system,...

How can CMS Reform the Medicare Hospice Payment System?

by Stephanie Reardon

CMS must update the Medicare hospice payment system using the data gathered by this audit in order to meet the ACA requirements. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its audit...


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