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


OIG: CMS Not Reducing Medicare, Medicaid Improper Payments

by Catherine Sampson

In testimony submitted to House of Representatives Subcommittee on Oversight and Investigations, the Office of Inspector General (OIG) urged the Centers for Medicare & Medicaid Services to work with states to correct gaps in their...

Providers Spend $15.4B to Report on Healthcare Quality Measures

by Catherine Sampson

General internists, family physicians, cardiologists, and orthopedists spend more than $15.4 billion annually to report on healthcare quality measures set by payers, according to a report from Health Affairs. Annually, these four types of practices...

CPC Initiative Improves Care Delivery But Not Medicare Spending

by Catherine Sampson

Although the Comprehensive Primary Care (CPC) initiative lead to progress in primary care delivery, it has not caused improvements in Medicare spending, patient experience or quality of care, researchers from The New England Journal of Medicine...

AHA: MACRA Alternative Payment Model Incentives Need Changing

by Catherine Sampson

The MACRA Alternative Payment Model incentives should be implemented in a way that provides the best opportunity for physicians to become qualifying participants, the American Hospital Association argued in a letter to CMS this week MACRA provides...

GAO: Millions Spent Yearly on Ineligible Medicaid Reimbursements

by Catherine Sampson

Ineligible managed care providers currently receive $3 million in Medicaid reimbursements annually, the Government Accountability Office (GAO) said in a report, due to the lack of effective screening processes. “The integrity of the Medicaid...

Providers Collect More Revenue Due to ACA Medicaid Expansion

by Catherine Sampson

In recent years, the Affordable Care Act (ACA) paved the way for significant Medicaid expansion. A recent study from the National Bureau of Economic Research found that Medicaid expansion resulted in financial benefits for low-income patients...

How MACRA, MIPS Will Impact Critical Access Hospitals, FQHCs

by Catherine Sampson

MACRA means different things to various types of healthcare providers, such as critical access hospitals, rural health clinics and Federally Qualified Health Centers. Although the new MACRA framework provides multiple paths to success with various...

Top 5 Facts to Know about MACRA Alternative Payment Models

by Catherine Sampson

CMS recently proposed a rule that would put last year's MACRA's legislation into action. The proposal introduces several significant changes to the way providers will attest to quality improvements and technology use, but also includes...

Number of Accountable Care Organizations Continue to Rise

by Catherine Sampson

The number of accountable care organizations (ACOs) continue to increase across the county. Earlier this year, the Centers for Medicare & Medicaid Services (CMS) announced 121 new Medicare Accountable Care Organization (ACO) participants. Between...

CMS Payment Reforms Mean Big Bucks for Medicare, Medicaid

by Catherine Sampson

Over the past month, CMS has announced finalized and proposed rules that would significantly impact payment policies in 2017 for managed care in Medicaid and the Children’s Health Insurance Program (CHIP) as well as Medicare hospice benefits,...

CMS Plans to Reverse Two-Midnight Rule for Medicare Payments

by Catherine Sampson

On April 18, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that addresses the problematic two-midnight rule that produced 0.2 percent payment reductions for certain hospital inpatient services. The new rule would...

CMS Extends Application Period for Next Generation ACO Model

by Catherine Sampson

Providers interested in participating in the Next Generation Accountable Care Organization (ACO) program now have until May 20, 2016 to submit their letters of intent, CMS announced this week. In order to apply to the Next Generation ACO Model,...

BMC Pays $1.1M to Resolve Medical Billing Fraud Allegations

by Catherine Sampson

Medical billing fraud, waste and abuse in Medicare and Medicaid appears to be an incurable disease. Although funds for these services are supposed to be for vulnerable populations with health needs, they are frequently used for other reasons....

Bundled Payments Program Extended to Improve Value-Based Care

by Jacqueline Belliveau

The Centers for Medicare & Medicaid Services (CMS) recently announced that some healthcare organizations can extend their participation in the Bundled Payments for Care Improvement (BPCI) initiative, a program that aims to increase value-based...

Accountable Care Organization Savings Shift After First Year

by Catherine Sampson

More than 700 accountable care organizations (ACO) currently work toward the goal of improving the quality of healthcare while also reducing capital costs of healthcare thanks to the Affordable Care Act. Meanwhile, researchers attempt to figure...

Healthcare Orgs to Review Healthcare Costs on Open Payments

by Jacqueline Belliveau

According to a recent blog post, CMS is offering healthcare providers a chance to review and dispute healthcare costs related to manufacturers and group purchasing organizations, which will be published on the Open Payments data website on June...

CMS Details How to Resolve ICD-10 Implementation Issues

by Jacqueline Belliveau

In the second update about ICD-10 implementation, CMS has released infographic and statement guidance on how to address issues and questions about IDC-10. The recent statement encourages providers to create a feedback system to review clinical...

CMS Demonstrates How to Track ICD-10 Implementation Progress

by Jacqueline Belliveau

CMS has recently released an infographic urging healthcare providers to assess and analyze their ICD-10 progress by identifying key performance indicators (KPIs) and creating baselines for analysis for each KPI. The recent announcement highlights...

CMS Seeks Final Applications for Next Generation ACO Model

by Jacqueline Belliveau

The Centers for Medicare and Medicaid Services Innovation Center announced the opening of its final round of applications for Next Generation Account Care Organization (ACO) Model, which will begin on January 1, 2017. The final round of Next...

ICD-10 Claim Denial Rate Remains Low among Most Providers

by Vera Gruessner

It seems that the ICD-10 implementation has not had a very negative effect on the ICD-10 claim denial rate, which hasn’t risen much since the October 1 deadline. For example, RelayHealth Financial, a revenue cycle management solutions provider,...


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