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

Healthcare Revenue Cycle

Healthcare Groups Offer 21 Prior Authorization Improvements

by Jacqueline Belliveau

A coalition of 17 healthcare industry groups recently called on health plans, benefit managers, and other healthcare stakeholders to change prior authorization requirements to improve care continuity, reduce provider burdens, and improve timely...

Executive Order Calls for ACA Financial, Marketplace Flexibility

by Jacqueline Belliveau

Just hours after taking office, President Trump signed a broad executive order that intends to minimize the “economic burden of the Patient Protection and Affordable Care Act” before an official repeal of the law. Under the executive...

HRSA Adds $5K Fines for 340B Prescription Drug Rate Overcharging

by Jacqueline Belliveau

Drug manufacturers participating in the 340B Drug Pricing Program who intentionally charge hospitals prescription drug rates higher than established ceiling prices will face a $5,000 penalty per instance, a new Health Resources and Services Administration...

3 Most Common Healthcare Supply Chain Management Challenges

by Jacqueline Belliveau

From gauze and paper gowns to implantable medical devices and prescription drugs, provider organizations must implement efficient healthcare supply chain management processes to cut overall costs and standardize care delivery. But for many organizations,...

Flexibility Key to Revenue Cycle Management Vendor Selection

by Jacqueline Belliveau

With thousands of healthcare revenue cycle management and business intelligence analytics vendors in the market, how does a provider organization decide on just one? According to Robert Creaven, CMPE, MPA, Executive Vice President of Operations...

VA Gives RNs Full Practice Authority to Improve Care Access

by Jacqueline Belliveau

The Department of Veterans Affairs (VA) will now give some advanced practice registered nurses full practice authority in order to boost care access and quality of care. However, certified registered nurse anesthetists will not benefit from expanded...

CMS Hinders Private Plan Steering for Claims Reimbursement Bump

by Jacqueline Belliveau

CMS recently released an interim final rule designed to prevent providers at Medicare-certified dialysis centers from inappropriately steering patients away from Medicare and Medicaid in order to get higher claims reimbursement rates under the...

Developing Post-Acute Networks for APM Reimbursement Success

by Jacqueline Belliveau

About 85 percent of healthcare C-suite leaders expect to expand post-acute care partnerships over the next three years, especially as their organizations aim to maximize alternative payment model reimbursement, a recent Premier report found....

AMGA: Value-Based Reimbursement Transition Slower Than Expected

by Jacqueline Belliveau

Fee-for-service revenue decreased by more than 20 percent as value-based reimbursement payments increased, reported the American Medical Group Association (AMGA). But the transition to value-based reimbursement may be slowing down compared to...

Providers Skip Healthcare Costs Talk with 68% of Cancer Patients

by Jacqueline Belliveau

As providers face increased patient financial responsibility, healthcare costs discussions with patients are becoming more important for obtaining full payment. But a new study from the Cancer Support Community showed that many providers are...

Staffing Shortages, Healthcare Reform Top C-Suite Concerns

by Jacqueline Belliveau

Healthcare C-suite executives identified staffing shortages and healthcare reform as having the largest impact of their organization’s ability to delivery care, a recent Premier survey found. About 41 percent of the 52 C-suite level respondents...

Price, Utilization Increases Upped Healthcare Spending by 4.5%

by Jacqueline Belliveau

Healthcare spending for privately insured individuals increased by 4.6 percent because of rising prices for outpatient, inpatient, and professional care services as well as prescription drugs, the Health Care Cost Institute (HCCI) recently reported....

OIG Identifies Top HHS Financial, Medicare Fraud Challenges

by Jacqueline Belliveau

The Office of the Inspector General (OIG) recently found the most significant management and performance challenges facing the Department of Health and Human Services (HHS), including financial management and Medicare fraud prevention inefficiencies....

Tips for Negotiating Claims Reimbursement Rates with Payers

by Jacqueline Belliveau

Every dollar counts in the healthcare revenue cycle, especially with declining Medicare reimbursement rates and new value-based care models. But organizations should understand how to successfully negotiate claims reimbursement contracts with...

How to Develop a Value-Based Care Implementation Strategy

by Jacqueline Belliveau

When building a value-based care strategy, healthcare organizations should focus on improving care delivery across skilled nursing facilities, at-home services, and end-of-life services, Steven Strongwater, MD, President and CEO of Atrius Health,...

Health Centers Face Post-ACA Revenue Cycle Management Issues

by Jacqueline Belliveau

Although the Affordable Care Act provided temporary funding to federally qualified health centers, a new study from the UCLA Center for Health Policy Research showed that community health centers will still need funding to resolve healthcare...

Only 23% Have Consumer-Centered Healthcare Capabilities

by Jacqueline Belliveau

While approximately two-thirds of healthcare leaders view consumer-centered healthcare as a priority, especially in light of value-based reimbursement, only 23 percent stated that their organization had the capabilities to develop consumer insights,...

PCP Awareness of Healthcare Costs Cuts Low-Value Resource Use

by Jacqueline Belliveau

Healthcare organizations can cut down on costly low-value services, such as antibiotic prescriptions for acute sinusitis or osteoporosis screenings for young patients, by educating primary care providers about healthcare costs, a recent study...

How to Improve Healthcare Mergers and Acquisitions Strategies

by Jacqueline Belliveau

Large and mid-size healthcare organizations should implement more proactive healthcare mergers and acquisitions strategies to avoid common acquisition mistakes, such as undefined growth strategies and deal overpayments, asserted Deloitte in a...

90% Report Clinical Documentation Improvement Boosted Revenue

by Jacqueline Belliveau

Nearly 90 percent of hospitals with 150 or more beds and outsourced clinical documentation functions realized at least $1.5 million in appropriate healthcare revenue and claims reimbursement following clinical documentation improvement (CDI)...

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