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

Medicare Reimbursement

How St. Luke’s CFO Succeeds at Revenue Cycle Management

by Jacqueline DiChiara

A successful hospital recognizes input reflects output when it comes to revenue cycle management. Highly effective performance initiatives regarding hospital care and management are often difficult to tangibly quantify but easy to recognize....

GA Hospital Overcharges Medicare Beneficiaries, Pays $20M

by Jacqueline DiChiara

The Medical Center of Central Georgia (MCCG), known as Medical Center, Navicent Health, the second largest hospital in Georgia, will pay $20 million for violating the False Claims Act, according to a report from the Office of Inspector General...

Integrated Community Oncology Practices Need Cost Efficiency

by Jacqueline DiChiara

Integrated community oncology practices represent a core foundation of cancer care by promoting a rewarding patient experience and helping cancer patients successfully battle complex social and health issues. Unfortunately, financial obstacles...

Does the Sustainable Growth Rate Mean Smarter Reimbursement?

by Jacqueline DiChiara

Last week, the House of Representatives passed legislation that permanently repealed the Sustainable Growth Rate (SGR) formula and established an original reimbursement plan with fundamentally implemented value-based care incentives. The Senate...

ICD-10 Preparation Means Actively Protecting Revenue Stream

by Jacqueline DiChiara

Provider organizations and physicians continue to prepare for the ICD-10’s unknown revenue impact as the October 1, 2015 looms nearer and providers seek to actively protect revenue stream. Pam Jodock, HIMSS Senior Director of Health Business...

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 —...

March 6: Week That Was in Healthcare Fraud and Malpractice

by Jacqueline DiChiara

Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility...

Why Site Neutral Payment Reimbursements Are Incomparable

by Jacqueline DiChiara

Legislation is under review for site neutral payment reimbursements where identical reimbursement is offered for two starkly contrasting types of patient care and resources. Congress will possibly implement a Medicare Payment Advisory Commission...

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...

Medicare Pushing Coordinated Care Efforts for Chronic Conditions

by Ryan Mcaskill

With two new fees, Medicare is adding incentives for doctors to better coordinate care for patients with chronic conditions. Back in November, the Department of Health and Human Services (HHS) released the 2015 final physician fee schedule...

How Effective is the Medicaid Drug Rebate Program?

by Stephanie Reardon

Rebate program saved Medicaid an average of $15 billion annually. The Affordable Care Act (ACA) will soon be reducing Medicaid reimbursement. A recent survey was conducted by the Office of Inspector General (OIG) to test the effectiveness of...

Study: Value-Based Medicare Payment Reform is Working

by Ryan Mcaskill

A study from Stanford University found a drop in hospital-acquired illnesses because of Medicare payment reform. There are several goals for payment reform in the healthcare industry. Ultimately it boils down to cost, effectiveness and value....

Medicare Part D Payments Made to Deceased Beneficiaries

by Ryan Mcaskill

An OIG report found that Medicare Part D paid HIV drugs for over 150 deceased beneficiaries in 2012. The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released a study of the Centers for Medicare & Medicaid...

Quincy Medical Closes after Cuts to Medicare, Patient Volume

by Jennifer Bresnick

Declining patient volumes and inadequate reimbursement have led to the closure of Quincy Medical Center in Massachusetts. Quincy Medical Center, which serves patients in the Greater Boston area, will shut down its inpatient services on December...

Examining Differences Between Medicare, Medicaid Reimbursement

by Ryan Mcaskill

While Medicare and Medicaid are similar programs, there offer different challenges when it comes to reimbursement. Medicaid and Medicare services are often lumped together because they are both government-sponsored healthcare programs. It is...

Recapping Finalized 2015 Rules from CMS on Medicare Payments

by Ryan Mcaskill

Several new rules for 2015 have been finalized and will have an impact on how Medicare pays major health care providers. Payers and providers in the Medicare program need to take notice of new rules that the Centers for Medicare and Medicaid...

Hospice Improperly Claimed $447K in Medicare Reimbursement

by Ryan Mcaskill

The office of inspector general (OIG) of the Department of Health and Human Services released the results of a study of Medicare reimbursement claims by The Community Hospice, Inc. The organization operates in New York State. According to the...


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