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

Revenue Cycle Management

Summary of CMS’s Top 5 Proposed Payment Rules, Revisions

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) has continuously released a steady stream of payment policies and physician fee schedules. As reported in a summary of top 6 previously proposed payment rules and...

CMS Administrator Slavitt Writes ICD-10 Letter to Providers

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) released a letter today addressed to Medicare providers about ICD-10. According to CMS Acting Administrator Andrew M. Slavitt, the healthcare industry and greater community will thrive...

CMS’s Fraud Prevention System Thwarts $820M in Payment Abuse

by Jacqueline DiChiara

A 10:1 return on taxpayer money is a rare feat. Nonetheless, an advanced state-of-the-art analytics system – the Fraud Prevention System – courtesy of The Centers of Medicare & Medicaid Services (CMS) is making such a goal tangible...

Praise for Patient-Centered Payment Models, Bundled Payments

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) apparently gets a big thumbs up this week. Leading consumer advocacy group, the National Partnership for Women & Families (NPWF), openly praises CMS for its efforts regarding patient-centered...

What is the New Future of Value-Based Payment Programs?

by Jacqueline DiChiara

Medicare’s value-based payment programs provide physicians with purposeful information that can be intelligently acted upon to resultantly strengthen care quality. As the shift from physician reimbursement moves from...

CMS Proposes Post-SGR Repeal Physician Fee Schedule Update

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) has released a projected update to the physician payment schedule. CMS’s proposal marks the first post-Sustainable Growth Rate (SGR) repeal through the Medicare Access and CHIP Reauthorization...

Analyzing the Highs and Lows of Children’s Healthcare Spending

by Jacqueline DiChiara

Healthcare spending for children is apparently on the up and up. It has increased more quickly than that of the total employer-sponsored insurance (ESI) population, according to a report from the Health Care Cost Institute (HCCI) which analyzes...

Will Less Specific ICD-10 Codes Ruin Future Data Quality?

by Jacqueline DiChiara

ICD-10 issues abound as the October transition date looms nearer. Of primary recent concern is that of coding specificity. Just as dialing only an isolated area code will not successfully connect you to a caller, a string of absent characters...

CMS Offers July ICD-10 Implementation Educational Sessions

by Jacqueline DiChiara

To enhance ICD-10 implementation readiness, The Centers for Medicare & Medicaid Services (CMS) is holding several in-person ICD-10 training sessions throughout upcoming weeks in July to assist small and rural healthcare...

Reconsidering ACA Limits, Fee-for-Value as Firm Payment Fix

by Jacqueline DiChiara

As the Affordable Care Act (ACA) continues to evolve, the healthcare industry thrives on crystal ball-esque predictions about what future challenges may arise. How will the Supreme Court’s King v. Burwell decision impact premiums and the...

Black, ACR Praise CMS’s ICD-10 12-Month Safe Harbor Period

by Jacqueline DiChiara

The American College of Rheumatology (ACR) and Congressman Diane Black (R-TN-06) applaud the Centers for Medicare & Medicaid’s (CMS’s) announcement this week to enact a 12-month safe harbor period following October’s...

Aetna Acquires Humana for $37B to Moderate Healthcare Costs

by Jacqueline DiChiara

Aetna has agreed to acquire its undersized competitor, Humana Inc, for $37 billion in cash and stock. The possible unifying together of two of the nation’s largest health insurers may generate an anticipated operating revenue this year...

What is the Future of Healthcare Mergers and Acquisitions?

by Jacqueline DiChiara

As healthcare mergers and acquisitions reach a record high, will financial consequences follow? The roles of critical access hospitals (CAHs) continue to change as more are closing their doors due to financial strain. There is solid debate among...

No Medicare Claim Denials After ICD-10 Transition, Says CMS

by Jacqueline DiChiara

ICD-10 implementation is now a horse of a different color. The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are seeing eye-to-eye on matters of ICD-10 and claims denial. CMS has outlined 4...

CMS, AMA Announce ICD-10 Deal to Avoid Financial Disruption

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Centers (CMS) and the American Medical Association (AMA) announce their collective agreement today on ICD-10 efforts. The primary objective from both organizations is to circumvent possible upcoming financial...

CMS Announces HPID Final Rule Public Commentary Period

by Jacqueline DiChiara

The Department of Health and Human Services (HHS) released a Request for Information (RFI) earlier this month on the Health Plan Identifier (HPID). HPID – a standard identifier for health plans – is required to be adopted under the...

July 2: 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...

Increased Deductibles Create More Revenue Cycle Challenges

by Jacqueline DiChiara

The ability to collect payment from patients has changed dramatically with the recent proliferation of high deductible health plans (HDHPs). Increased deductibles mean more revenue cycle challenges. There has been a significant increase within...

Top 5 Facts and Misconceptions about the ICD-TEN Act

by Jacqueline DiChiara

The bipartisan ICD-TEN Act is perhaps sparking confusion among the healthcare industry. As part of a recent series of ICD-10-based bill proposals, including a two-year “grace period” without denials to avert unfair penalizations to...

100 Day ICD-10 Countdown: CMS’s Top 5 Steps for Readiness

by Jacqueline DiChiara

The official 100 day countdown until the October 1 ICD-10 implementation deadline recently came and went. To foster industry-wide knowledge and preparation, the Centers for Medicare & Medicaid Services (CMS) introduces a series of the following...


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