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

Medicare Reimbursement

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...

May 8: 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 (DOJ) and the Office of Inspector General (OIG). The crimes reported below result in multiple millions...

Next Generation Analytics Demand Actionable Results

by Jacqueline DiChiara

The value-based reimbursement movement has a leader. That leader is the Centers for Medicare & Medicaid Services (CMS). Indeed, there has been a great deal of hustle and bustle regarding many recent initiatives from CMS,...

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...

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