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

Medicare Reimbursement

Value-Based Care Reimbursement Needs Greater Customization

by Vera Gruessner

With rising healthcare spending found throughout the US, the federal government has put greater focus on value-based care reimbursement than ever before. Healthcare providers and payers are seeking ways to move beyond fee-for-service payment...

CMS Proposes New Healthcare Payment Models for Medicare Part B

by Vera Gruessner

New healthcare payment models are being advised by the Centers for Medicare & Medicaid Services (CMS). From alternative payment models to the Medicare Shared Savings Program and the Comprehensive Care for Joint Replacement program, the federal...

Revenue Cycle Management Success is About the Fundamentals

by Jacqueline DiChiara

Revenue cycle management success is the heart of any healthcare organization. Defined as the clinical and administrative management of claims management, payment, and revenue production, revenue cycle management is in essence one large financial...

CMS Reports SNF Payment Incentives May Cut Medicare Spending

by Jacqueline DiChiara

Medicare spending is falling, according to an annual report from the Centers for Medicare & Medicaid Services (CMS) that assessed how to reduce avoidable hospitalizations for long-stay nursing facility residents. Well-targeted...

What Are the Greatest Revenue Cycle Management Challenges?

by Jacqueline DiChiara

RevCycleIntelligence.com recently polled over 60 readers to assess revenue cycle management challenges and opportunities, from the front-end, to the back-end, and everything in between. Readers said collecting payment from a patient in a timely...

55 Hospitals File Two-Midnight Rule Lawsuit Against HHS

by Jacqueline DiChiara

The healthcare industry is burning the two-midnight oil. Fifty-five hospitals filed a lawsuit last Friday against the Department of Health and Human Services (HHS) regarding the two-midnight rule’s 0.2 percent inpatient compensation...

HHS, CMS Speak Out on CMS’s Innovation Center Pilot Project

by Jacqueline DiChiara

Medicare reimbursements are preparing to emerge from a fee-for-service caterpillar’s cocoon to a value-based butterfly. The newly announced Accountable Health Communities [AHC] model – a CMS Innovation Center Pilot...

How Advanced Care Discussions Impact Provider Payment Focus

by Jacqueline DiChiara

Critical end-of-life discussions between a physician, a patient, and a patient’s family or loved ones, are perhaps being glossed over more and more because of reimbursement challenges. The Centers for Medicare & Medicaid Services (CMS)...

Top 6 Trending Payment Models Demanding New Long-Term Focus

by Jacqueline DiChiara

Time is money, especially when it comes to healthcare. Paying for outcomes gained instead of mere services rendered is the new name of the healthcare game. This means the simple notion of paying for multiple physician visits, medical...

CMS Announces Two-Midnight Payment Cut Commentary Period

by Jacqueline DiChiara

A notice and accompanying commentary period released yesterday from The Centers for Medicare & Medicaid Services (CMS) examines the core issue behind slashing hospital inpatient payments by 0.2 percent. This financial cut is tied to a “two-midnight...

Why Value-Based Care Yields Lower Cost, Higher Quality Care

by Jacqueline DiChiara

Value-based care is in the lead compared to its fee-for-service competitor, according to Humana’s new Medicare Advantage population health results. “Members treated under the care of providers in value-based reimbursement models with...

Are Medicare Pay-for-Performance Benefits Worth the Risk?

by Jacqueline DiChiara

Medicare pay-for-performance (P4P) incentives are inadvertently averting money away from those financially aching hospitals primarily serving minorities and the economically disadvantaged to instead inflate the revenues of those hospitals serving...

How to Rescue Revenue Cycle with Medicare Appeals Pending

by Jacqueline DiChiara

The rehabilitation needs of Medicare beneficiaries within the state of California may be in jeopardy. Payment for hundreds of thousands of claims for services is being denied. Most of these denials are reportedly invalid, confirms past appeal...

HHS Urged to Resolve Pending Medicare Appeals in Filed Suit

by Jacqueline DiChiara

Casa Colina Hospital and Centers for Healthcare recently filed suit to require timely Medicare patient care appeals mandated under federal law.  The Medicare program is denying payment for hundreds of thousands of claims for services....

Readers Debate the Affordable Care Act’s Anticipated Impact

by Jacqueline DiChiara

Is the Affordable Care Act (ACA) a beautiful success, a gut-wrenching failure, or a complexly vague combination of both? Simply put, opinions are mixed. Some across the healthcare industry confirm various ACA successes – more uninsured...

CMS Extends Upcoming Two-Midnight Partial Enforcement Delay

by Jacqueline DiChiara

The partial enforcement delay of the two-midnight policy originally set for September 30, 2015 expiration has been extended by the Centers for Medicare & Medicaid Services (CMS) through December 31, 2015, confirms the American Hospital...

Healthcare Experts Speak Out on Rural Hospitals’ Medicare Cuts

by Jacqueline DiChiara

As RevCycleIntelligence.com recently reported, recent Congress testimony from 4 rural hospital leaders representing the Centers for Medicare & Medicaid Services (CMS) demanded urgently implemented change to alleviate rural hospitals’...

Accountable Care Organizations Need Financial Accountability

by Jacqueline DiChiara

Accountable care organizations (ACOs) necessitate the recognition of collective accountability for a distinct population’s cost and quality of care. Although they may be slowly on the rise within the healthcare industry, their successful...

May 15: 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 and the Office of Inspector General. The crimes reported below result in multiple millions of dollars...

Rural Hospitals Address Medicare Reimbursement Cut Concerns

by Jacqueline DiChiara

Rural hospitals may be losing the Medicare reimbursement battle. Legislative pushes are being considered by Congress to alleviate the possible financial death of the rural hospital as reimbursement cuts continue to weaken the financial backbone...

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