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

Policy & Regulation News

ICD-10 System Codes Will See New Updates by October 1


The ICD-10 implementation deadline and postponements brought a variety of challenges to the healthcare field. One of those obstacles has been the constant ICD-10 system code freezes. However, on October 1, 2016, the healthcare industry will move...

CMS May Save $343 Million through Surgical Bundled Payments


The Centers for Medicare & Medicaid Services (CMS) launched the Comprehensive Care for Joint Replacement Model a little more than a week ago. This program is meant to issue bundled payments for a particular episode of care - in this case,...

Does Medicaid Expansion Improve Revenue of Hospitals?


The Affordable Care Act and Medicaid expansion has had a significant impact on hospitals around the country since full coverage for millions of Americans would lead to greater utilization of healthcare services and possibly strain the resources...

21 States Have Overbilled the FFS Medicare Program


New research from the Centers for Medicare & Medicaid Services (CMS) shows that 21 states have above average rates of overbilling the Medicare program. The Supplementary Appendices for the Medicare Fee-for-Service (FFS) Improper Payment Report...

Value-Based Care Final Rule to Implement MACRA Sent to OMB


The final rule for implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) — and its provisions for value-based care and reimbursement — is now in the hands of the Office of Management and Budget (OMB) according...

CMS, CDC Add More than 5,000 Codes to ICD-10 Coding System


Last week, the Centers for Disease Control and Prevention along with the Centers for Medicare & Medicaid Services (CMS) announced some major news for the ICD-10 coding system. The two organizations have added more than 5,000 new ICD-10 diagnosis...

Medicare Spending Increases Slightly under Affordable Care Act


In 2014, Medicare spending for personal healthcare expenditures only increased by 2.4 percent per person and decreased by 3.6 percent for Medicaid, a recent report by the Department of Health and Human Services (HHS) stated. In comparison, overall...

Health Insurance Exchange Tips for Taxpayers Before April 15


With the deadline for filing this year’s taxes just around the corner, it is useful for insurance consumers to refresh the requirements of tax filing when covered through the health insurance exchange. The majority of people who purchase...

CMS Details How to Resolve ICD-10 Implementation Issues


In the second update about ICD-10 implementation, CMS has released infographic and statement guidance on how to address issues and questions about IDC-10. The recent statement encourages providers to create a feedback system to review clinical...

House Budget Proposes ACA Repeal, Reduced Medicare Spending


The House of Representatives proposed budget plan for 2017 from the House Budget Committee aims to repeal the Affordable Care Act (ACA), reduce Medicare spending, and give states more control with health programs. “With respect to health...

CMS Awards Equipment Contracts to Reduce Medicare Spending


CMS continues to reduce Medicare spending by awarding contracts to successful bidders for Medicare’s Round 2 and national mail-order recompetes and releasing new single payment amounts for the Durable Medical Equipment, Prosthetics, Orthotics,...

Lack of Medicaid Expansion Leads to Hospital Revenue Loss


Ever since a number of states refused to expand their Medicaid programs and receive the majority of funding for this enterprise from the federal government, there has been a division of revenue between states that have broadened Medicaid coverage...

CMS Demonstrates How to Track ICD-10 Implementation Progress


CMS has recently released an infographic urging healthcare providers to assess and analyze their ICD-10 progress by identifying key performance indicators (KPIs) and creating baselines for analysis for each KPI. The recent announcement highlights...

3 Key Steps to Continue ICD-10 Implementation Progress


Now that the ICD-10 implementation has been deemed a relative success throughout the healthcare industry, the Centers for Medicare & Medicaid Services (CMS) are focused on continuing the progress related to the ICD-10 implementation. CMS...

Value-Based Reimbursement May Not Bring Benefits for SNF Care


CMS has released the Skilled Nursing Facility Utilization and Payment Public Use File, a dataset on the care skilled nursing facilities (SNF) provided to Medicare beneficiaries in 2013.  The data raises questions about the effect of...

CMS Proposes New Healthcare Payment Models for Medicare Part B


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...

Medicaid Program Advances Patient Engagement, Interoperability


At the HIMSS16 conference in Las Vegas, the Centers for Medicare & Medicaid Services (CMS) will be presenting a discussion revolving around how health IT applications could incentivize patient engagement. The panel discussion will incorporate...

ICD-10 Claim Denial Rate Remains Low among Most Providers


It seems that the ICD-10 implementation has not had a very negative effect on the ICD-10 claim denial rate, which hasn’t risen much since the October 1 deadline. For example, RelayHealth Financial, a revenue cycle management solutions provider,...

CMS Releases Post-ICD-10 Claims Denial Reimbursement Metrics


Post-ICD-10 implementation claims denial is a top 2016 focus for healthcare organizations. According to last month’s ICD-10 survey from Porter Research and Navicure, healthcare organizations cite value-based care as a leading focus. Sixty...

Medicaid Expansion Decisions Cost Hospitals, States Billions


Medicaid expansion rejection is costing various states across the nation a great deal of money. The voluntary decision to not implement Medicaid expansion is potentially harmful for revenue cycle management. Expansion states have been experiencing...


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