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

Affordable Care Act

Medicare Spending Increases Slightly under Affordable Care Act

by Jacqueline Belliveau

In 2014, Medicare spending for personal healthcare expenditures only increased by 2.4 percent per person and decreased by 3.6 percent for Medicaid, a recent report by the Department of Health and Human Services (HHS) stated. In comparison, overall...

Health Insurance Exchange Tips for Taxpayers Before April 15

by Vera Gruessner

With the deadline for filing this year’s taxes just around the corner, it is useful for insurance consumers to refresh the requirements of tax filing when covered through the health insurance exchange. The majority of people who purchase...

House Budget Proposes ACA Repeal, Reduced Medicare Spending

by Jacqueline Belliveau

The House of Representatives proposed budget plan for 2017 from the House Budget Committee aims to repeal the Affordable Care Act (ACA), reduce Medicare spending, and give states more control with health programs. “With respect to health...

CMS Releases 2016 Results for Value-Based Care Program

by Jacqueline Belliveau

The Center for Medicare and Medicaid Services (CMS) released the results for calculating the 2016 Value Modifier, which will come as financial boost to some and hindrance to others. Out of the 8,395 eligible physician groups, which satisfactorily...

9.4 Million Fewer Americans Struggle to Pay Medical Bills

by Vera Gruessner

Several years after the implementation of the Patient Protection and Affordable Care Act, the results seem to be showing that fewer Americans are struggling with paying medical bills and more than ever before have gained health insurance coverage....

Providers Squeezed to Integrate Care Management Solutions

by Vera Gruessner

At this year’s HIMSS conference and exhibition, Chilmark Research released the 2016 Care Management Market Trends report, which outlines how the market is leaning on healthcare providers to create care management solutions. The report also...

Examining the Value-Based Alternative Payment Model Basics

by Jacqueline DiChiara

Alternative payment models like the accountable care organization (ACO) and the bundled payment model have been gaining popularity under the Affordable Care Act’s (ACA) mandates. Figuring out how alternative payment models will evolve under...

CMS Provider Data Combats Medicare, Medicaid, CHIP Fraud

by Jacqueline DiChiara

To help combat healthcare fraud, the Centers for Medicare & Medicaid Services (CMS) has released a new pair of public data sets to promote greater Medicare and Medicaid data transparency and cut down on Medicare and Medicaid fraud,...

Price Transparency Still Missing from Hospital Revenue Cycle

by Jacqueline DiChiara

The Affordable Care Act’s (ACA) numerous price transparency provisions are inefficient, says a policy brief from the Pioneer Institute. Hospital executives must make consumer-friendly pricing information a top revenue cycle focus or else...

2 Medicare Alternative Payment Models Demanding Future Focus

by Jacqueline DiChiara

Medicare alternative payment models have the ability to make affordable, high quality care a reality. But providers still demand greater levels of care coordination and cleaner streamlining of clinical data to achieve value-based reimbursement...

Shared-Decision Making Advances Value-Based Care Outcomes

by Jacqueline DiChiara

Shared-decision making promotes strong dialogue between healthcare providers and healthcare consumers and builds stronger value-based care outcomes. At its core, shared-decision making gives beneficiaries more choice about their care and treatment...

CMS Rule Addresses Medicare Fraud, Overpayment Compliance

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) published a final rule this week focused on improving Medicare compliance, reporting, and self-identified overpayments to ultimately combat Medicare fraud. Under...

How Do High-Deductible Plans Affect Value-Based Care Goals?

by Jacqueline DiChiara

Value-based care outcomes are shaped by a variety of factors – but especially the ever influential high-deductible health plan (HDHP). The recent significant increase of HDHPs across the healthcare industry is apparently tied to their...

The Affordable Care Act’s Effect on Hospital Charity Care

by Jacqueline DiChiara

Hospitals provide charity care according to patients’ income levels. But policies and patient criteria often vary depending on the particular hospital. Supporting hospital charity care while maintaining tight margins is a challenge, especially...

Affordable Care Act Saved Medicare Beneficiaries $20 Billion

by Jacqueline DiChiara

The Affordable Care Act (ACA) has saved over 10 million Medicare beneficiaries upwards of $20 billion on prescription drugs over the past six years, according to new information from the Centers for Medicare & Medicaid Services (CMS). Millions...

CMS Says Alternative Payment Models Still Have a Way to Go

by Jacqueline DiChiara

Leading healthcare experts are speaking out about whether or not the healthcare industry is making progress in regard to alternative payment models. The healthcare industry is apparently on the right track thus far. Thirty percent of all Medicare...

AHA: Stark Law Exception Advances Alternative Payment Models

by Jacqueline DiChiara

Congress should focus on improving federal fraud and abuse laws, said the American Hospital Association (AHA) to the Senate Finance and House Ways and Means Committee last week. The AHA advocated for an exception to be created under the anti-kickback...

How the Affordable Care Act Refines Revenue Cycle Management

by Jacqueline DiChiara

The Affordable Care Act (ACA) provides many greater opportunity for healthcare providers to strengthen their revenue cycle operations. As a consumer-driven revenue cycle management is becoming the new norm, the ACA plays an active role in healthcare’s...

Affordable Care Act Creates Tax-Funded Expenditure Majority

by Jacqueline DiChiara

Over 64 percent of healthcare spending is tied to tax-funded expenditures, according to new data from the American Journal of Public Health. This reported number apparently contradicts commonplace perceptions about the cost of healthcare. Researchers...

CMS Tackles Medicare Spending, Medicaid Financial Incentives

by Jacqueline DiChiara

Medicare and Medicaid spending demands closer alignment for healthcare providers to better manage costs, according to a new report from the Centers for Medicare & Medicaid Services (CMS). A CMS/state partnership Capitated...

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