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

Healthcare Spending

CAGW criticizes CMS, Marilyn Tavenner for ACA expenditures

by Elizabeth Snell

Last week, Citizens Against Government Waste (CAGW) stated that the Centers for Medicare & Medicaid Services (CMS) had a “dismal record on financial accountability” and also knocked the organization for dismantling “one...

Youth mental health services to receive $99M in HHS funding

by Elizabeth Snell

The Department of Health and Human Services (HHS) took a huge step forward this week to increase access to mental health services for young people. HHS Secretary Sylvia M. Burwell announced that the agency awarded $99 million in grants to help...

Rate review programs reduce healthcare premiums by $993M

by Elizabeth Snell

The US Department of Health & Human Services’ (HHS) Rate Review Program and Rate Review Grant Program have shown success since their implementations in 2011 and 2010, respectively. Combined, the two programs have reduced total premiums...

Safeguards possibly ineffective on some copayment coupons

by Elizabeth Snell

Pharmaceutical manufacturers’ current safeguards may not prevent all copayment coupons from being used for drugs paid for by Part D, according to a recent Office of Inspector General (OIG) report. The coupons are typically offered to reduce...

Ala. organization overdrew $15M in federal Medicaid funds

by Elizabeth Snell

From 2010 to 2012, the Alabama Medicaid Agency withdrew $14.8 million that exceeded net Medicaid expenditures, according to a recent Office of Inspector General (OIG) report. Specifically, the state agency obtained $18.9 million more in federal...

Medicare ACOs improve care, save $372M in healthcare costs

by Elizabeth Snell

Medicare Accountable Care Organizations (ACOs) improved patient care and generated over $372 million in total program savings, according to the Center for Medicare & Medicaid Services (CMS). The Medicare Shared Savings Program (MSSP) and...

More parents uninsured in states lacking Medicaid expansion

by Elizabeth Snell

States that did not expand Medicaid could be more likely to have uninsured parents, according to a recent Urban Institute survey. The number of uninsured parents living in states that have not expanded Medicaid increased from 50.9 percent in...

Research finds higher Medicare spending in unhealthy states

by Elizabeth Snell

Socioeconomic factors that affect the need for medical care, along with interactions between the Medicare system and other parts of the health system are main reasons why there is variation in Medicare health spending between states, according...

2015 proposed outpatient PPS policy changes, payment rates

by Elizabeth Snell

On Monday, July 14, 2014, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule that would update the payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments...

2015 inpatient psychiatric facility PPS final rule

by Elizabeth Snell

On Wednesday, August 6, 2014, the Centers for Medicare & Medicaid Services announced its final rule for updating the prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs). The...

Summary of FY 2015 Hospice Payment Rate Update

by Elizabeth Snell

On Friday, August 22, 2014, the Centers for Medicare & Medicaid Services (CMS) released the 2015 Hospice Payment Rate final rule, which covers hospice payment rates and the 2015 wage index. The overall economic impact of this final rule is...

Proposed 2015 home health PPS refinements, rate update

by Elizabeth Snell

On Monday, July 7, 2014, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule for the home health prospective payment system (HH PPS) refinements and refine update for the calendar year (CY) 2015. The proposed rule...

2015 skilled nursing facility PPS, consolidated billing

by Elizabeth Snell

On Tuesday, August 5, 2014, the Center for Medicare & Medicaid Services announced its final rule updates for the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2015. ...

CMS falls behind on regulating rural health clinics

by Elizabeth Snell

The Centers for Medicare & Medicaid Services (CMS) has not issued final regulations to a portion of Rural Health Clinics (RHCs) that would enable those facilities to be considered an essential healthcare provider, according to a recent report...

Are health insurance exchanges the way of the future?

by Elizabeth Snell

Retail organizations faced with increasing healthcare costs and regulatory demands are increasingly looking toward health insurance marketplaces – also known as exchanges – when it comes to their employees’ coverage options, according to...

Does Vermont have the least expensive healthcare costs?

by Elizabeth Snell

Vermont residents could be paving the way for the rest of the nation in terms of healthcare spending patterns, as a recent report found that those living in the Green Mountain State spent fewer dollars on healthcare between 2007 and 2011. However,...

Kansas Medicaid experiences $72 million setback

by Elizabeth Snell

The three insurers administering Kansas Medicaid coverage lost $72.6 million in the first half of 2014. This is just the next step in a downward trend, as the KanCare system lost $110 million in 2013. “These companies can’t keep subsidizing...

How personalized preventative care reduces Medicare spending

by Elizabeth Snell

A primary care model that focuses on personalized preventive medicine can reduce Medicare Advantage spending, according to a recent report published in the American Journal of Managed Care (AJMC). Researchers studied costs within the MD-Value...

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