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

Healthcare Revenue Cycle

How to Prepare for Alternative Payment Model Implementation

March 23, 2017 - Implementing interoperable health IT infrastructure and a staffing model that aligns with value-based care requirements are key to successfully participating in an alternative payment model, Marjie Harbrecht, a Medical Group Management Association (MGMA) consultant, recently told RevCycleIntelligence.com. “We have to start sharing information in a much better way and coordinating...


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How to Prepare for Alternative Payment Model Implementation

by Jacqueline Belliveau

Implementing interoperable health IT infrastructure and a staffing model that aligns with value-based care requirements are key to successfully participating in an alternative payment model, Marjie Harbrecht, a Medical Group Management Association...

Managing Healthcare Costs, Data Analytics Top C-Suite Priorities

by Jacqueline Belliveau

Under the Trump administration, the healthcare industry is bracing for some significant policy changes, such as a potential Affordable Care Act repeal. Despite the political change, healthcare executives still plan to make healthcare cost management...

Physician Shortage Projected to Grow to 104K Providers by 2030

by Jacqueline Belliveau

The physician shortage is projected to grow to up to 104,900 providers by 2030, new research from the Association of American Medical Colleges (AAMC) revealed. The projected physician shortage increased from an estimated shortfall of up to 90,000...

Tracking Key Hospital Revenue Cycle Metrics to Up Profitability

by Jacqueline Belliveau

As the value-based reimbursement transition rolls on, many hospitals have adopted “If you can measure it, you can manage it” as their new motto. But how can providers and executives measure hospital revenue cycle management? Hospital...

Hospitals Seek Independent Docs for Referrals, Healthcare Revenue

by Jacqueline Belliveau

A recent SCI Solutions survey found that 58 percent of independent providers do not have one or more preferred referral hospital partners, suggesting a major healthcare revenue opportunity for health systems and hospitals. Out of the 549 independent...

52% of Practices Use Various Reminders to Stop Patient No-Shows

by Jacqueline Belliveau

To prevent patient no-shows, a recent Medical Group Management Association (MGMA) poll showed that providers are using a variety of communication methods to protect their healthcare revenue from missed appointments. The recent survey of 1,279...

AHA, FAH Oppose Proposed Physician Self-Referral Law Changes

by Jacqueline Belliveau

The American Hospital Association (AHA) and the Federation of American Hospitals (FAH) recently urged lawmakers to oppose a proposed bill that would extend physician self-referral allowances to physician-owned hospitals. In late February, House...

Diabetes Clinic Lowers Healthcare Costs More Than PCP Visits

by Jacqueline Belliveau

A California-based health system reduced healthcare costs by 2.5 percent more for diabetes patients by implementing a clinic that brings endocrinologists and pharmacists together to better manage medically complex diabetic patients, a recent...

Using Bundled Payments to Pay Providers for mHealth Nudges

by Jacqueline Belliveau

Many providers have been able to extend their reach outside of their office by using mHealth technologies that encourage patients to improve their own health outcomes through nudges. However, payment structures for the healthcare encounters have...

Top 5 Ingredients of a Successful Alternative Payment Model

by Jacqueline Belliveau

Alternative payment models tie provider reimbursement to quality and cost performance. Besides their foundational function, though, each model has its own rules pertaining to financial incentive structures, quality measurements, and patient populations...

Top 4 Claims Denial Management Challenges Impacting Revenue

by Jacqueline Belliveau

For most healthcare organizations, claim denials are a normal, if not a frequent, occurrence. While very few can boast that their denial rates are close to zero, many providers face a number of challenges with implementing an effective claims...

46% of Providers Unsure About Value-Based Purchasing Impact

by Jacqueline Belliveau

Value-based purchasing is not a new term for many providers, yet 46.4 percent of healthcare providers and leaders are still unsure how the shift away from fee-for-service payments will impact their revenue cycles, a recent Physicians Practice...

Health IT, Care Navigators Most Effective at Lowering Costs

by Jacqueline Belliveau

While countless strategies are out there for making care delivery more efficient, a recent Health Affairs study revealed that interventions that use health IT and community health workers realized the greatest cost savings. Researchers examined...

NH Judge Rejects CMS FAQs Clarifying Medicaid DSH Payments

by Jacqueline Belliveau

A district court in New Hampshire recently prohibited CMS from enforcing two Frequently Asked Questions (FAQs) that clarified how private payer and Medicare reimbursements paid to hospitals for dually-eligible Medicaid patients would be used...

AMGA Backs CMS Proposal to Limit 2018 Medicare Encounter Data

by Jacqueline Belliveau

The American Medical Group Association (AMGA) recently supported a CMS proposal to delay the increased use of encounter data to determine Medicare Advantage plan risk scores and claims reimbursement amounts. In a recent proposed rule, CMS stated...

FFS Compensation Linked to More Stroke Prevention Surgeries

by Jacqueline Belliveau

A new study in JAMA Surgery found that providers with fee-for-service compensation performed more carotid stenosis interventions on symptomatic and asymptomatic patients compared to providers reimbursed by a salary. Using data from the Military...

65% of Organized Providers Paid Via Alternative Payment Models

by Jacqueline Belliveau

Nearly two-thirds of healthcare providers in some type of integrated employment model, such as integrated health networks, physical hospital organizations, accountable care organizations, and large medical groups, are primarily reimbursed through...

Exploring MIPS Advancing Care Info, Improvement Activities

by Jacqueline Belliveau

At HIMSS17, CMS leaders took the stage to ease provider concerns about the newly launched Quality Payment Program and its more popular value-based reimbursement track, the Merit-Based Incentive Payment System (MIPS). Following up on their MIPS...

Preparing Providers for the Healthcare Consumerism Shift

by Jacqueline Belliveau

With a couple of swipes and clicks, patients are driving the shift to healthcare consumerism in the palm of their hands. But many healthcare organizations are not finding it as easy to align their care delivery and patient collection strategies...

Provider Profitability Tops Healthcare Revenue Cycle Concerns

by Jacqueline Belliveau

One of the top healthcare revenue cycle concerns with 40 percent of providers is maintaining profitability while remaining independent, a recent RemitDATA survey revealed. The survey of healthcare providers, billing companies, and vendors showed...

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