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


Many Denials, Rejections to Follow the ICD-10 Transition?

by Jacqueline DiChiara

After profuse speculation and ample delay, the deadline for the healthcare industry ICD-10 transition remains set for Oct. 1, 2015. As popular speculation of especially disastrous results prospers, it is feasible massive denials and rejections...

AMA President Urges Physicians Prepare for ICD-10 Transition

by Jacqueline DiChiara

A recent letter from the American Medical Association (AMA) and 99 other physician groups to the Centers for Medicare & Medicaid Services (CMS) expressed collective concern that effective contingency plans require further completion to prevent...

High Critical Access Hospital Reimbursement Costs Medicare

by Jacqueline DiChiara

Swing-bed services provided at 90 percent of critical access hospitals (CAHs) could have been avoided by use of neighboring alternative facilities during 2010, reports the Office of Inspector General (OIG). If swing-bed services at CAHs —...

Medicare Advantage Average Payment Cut Hurts Beneficiaries

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) proposes to slash Medicare Advantage (MA) and Medicare Part D (MAPD) plan payments next year by an average payment cut of .95 percent, as stated in February’s 2016 Calendar Year (CY)...

Does 2015 ICD-10 Transition Mean Millions in Unpaid Claims?

by Jacqueline DiChiara

A hundred physician groups, including the American Medical Association (AMA), expressed strong trepidation regarding the potential for a dangerous accumulation of millions of dollars in unpaid Medicare claims when the ICD-10 transition goes into...

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...

GAO Recommends Changes to Medicaid Reimbursement Technology

by Jacqueline DiChiara

A new United States Government Accountability Office (GAO) survey of the Medicaid program integrity systems in ten nationwide areas found there is a substantial puzzle piece missing within the world of information technology (IT) and Medicaid...

CMS Report Details Impact of Widespread Quality Measures

by Jacqueline DiChiara

Centers for Medicare and Medicaid Services (CMS) announces the release of a new CMS report, the 2015 National Impact Assessment of Quality Measures Report, a comprehensive assessment of CMS’ quality measures. The report employs nine key...

How Will the Value-Based Payment Modifier Impact Quality

by Jacqueline DiChiara

The Centers for Medicare & Medicaid (CMS) posted results this week from first-year implementation of the Value-based Payment Modifier (VM), which rewards physicians who provide economical and valuable care. The Value Modifier – part...

Does Successful ICD-10 Testing Mean a Smooth Transition?

by Jacqueline DiChiara

The International Classification of Diseases (ICD) is used to standardize codes for medical conditions and procedures. The Centers for Medicare & Medicaid Services (CMS) is assisting and supporting industry stakeholders with the October 1,...

Navicure Survey Shows ICD-10 Transition Financial Challenges

by Jacqueline DiChiara

A third ICD-readiness national survey was released on Tuesday via cloud-based healthcare billing and payment solutions provider Navicure in collaboration with Porter Research. A follow up to prior surveys from April and November 2013, concluding...

Hospital Claims $173,000 in Medicare Overpayments

by Stephanie Reardon

Hospital did not fully comply with Medicare requirements for billing inpatient and outpatient services. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its audit on Utah Valley Regional...

Groups Question Changes to Medicare Shared Savings Program

by Stephanie Reardon

118 out of 220 participating Medicare Shared Savings Program ACOs generated savings through reduced costs, but only 58 of these ACOs managed to meet the shared savings threshold. Seventeen medical organizations which includes the American College...

AHA Reacts to Proposed Rule for Medicare Shared Savings Program

by Stephanie Reardon

CMS’s proposed changes to the Medicare Shared Savings Program would save approximately $280 million more than the median net savings in federal funds from 2016 through 2018. The Medicare Shared Savings Program (MSSP) seeks to save money...

Medicare Overpays Hospital $414,000 for Incorrect Medical Billing

by Stephanie Reardon

The Hospital did not fully comply with Medicare requirements resulting in approximately $414,000 in overpayments for incorrect medical billing. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results...

CMS Announces Year Two of Open Payments Database

by Ryan Mcaskill

March 31, 2015 is the deadline for data submission in the second year of the Open Payments database. The first year of the Centers for Medicare & Medicaid’s (CMS) Open Payments database has been rocky at best. Created by the Affordable...

California State Agency Claims $375,000 in Non-Compliant Medicaid Fees

by Stephanie Reardon

Out of 100 beneficiary-services six had not complied with federal regulations leading to over payment in Medicaid fees. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its audit on Medicaid...

CMS Announced Possible Changes to EHR Incentive Program

by Ryan Mcaskill

CMS plans to tweak the EHR Incentive program to better align its goals with the feedback it has received from providers. Earlier this week, we reported on the upcoming February 28, deadline for healthcare providers that are eligible for the Medicare...

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...


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