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

Latest RCM News News

Brigham and Women’s Offers Buyouts to Lower Healthcare Costs

April 27, 2017 - Boston-based Brigham and Women’s Hospital recently presented 1,600 employees with a voluntary buyout option in an effort to control the facility’s healthcare costs, a local news source reported. Hospital officials reassured reporters at The Boston Globe that Brigham and Women’s was still profitable, collecting about $2.7 billion in revenue and $93 million in operations during...


Articles

CMS Expects to Release MIPS Participation Status By May 2017

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CMS anticipates notifying eligible clinicians about their Merit-Based Incentive Payment System (MIPS) participation status for 2017 via letter between late April through May, a recent email from the federal agency stated. The announcement (via...

CMS Calls On Rural Hospitals to Join Alternative Payment Model

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CMS is seeking applicants to participate in a new round of the Rural Community Hospital Demonstration Program that tests a cost-based alternative payment model among small rural hospitals. Lawmakers authorized a five-year extension of the demonstration...

CMS Suggests Hospital Medicare Reimbursement Policy Changes

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CMS recently suggested changes to Medicare reimbursement policies for hospital admissions and long-term care hospital stays as well as several recommendations for other Medicare value-based purchasing programs. The proposed rule released on April...

32 Orgs to Cut Healthcare Costs, Use Under CMS Community Demo

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As part of the Accountable Health Communities Model, CMS recently selected 32 organizations to participate in two of the three program tracks that aim to lower healthcare costs and utilization by fostering clinical and community service provider...

CMS Pauses Home Health Pre-Claim Review Demonstration

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CMS recently halted the home health Pre-Claim Review demonstration in Illinois for 30 days and the program will not expand to Florida as expected in April 2017, according to the federal agency’s website. “After March 31, 2017, and...

AMGA President, CEO Donald W. Fisher, PhD, Passes at 71

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AMGA President and CEO, Donald W. Fisher, PhD, CAE, passed earlier this week after battling cancer, the healthcare industry group reported. Fisher, who was 71 years old, had led the organization since 1980. “Don leaves a professional and...

CMS Delays Rollout of Cardiac, Ortho Bundled Payment Programs

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CMS is pushing back the start date for a number of its bundled payment programs in an effort to provide additional time to review and prepare for the initiatives. In a notice posted in the Federal Register, CMS has issued three-month delays for...

Senate Confirms Seema Verma as Next CMS Administrator

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In a 55 to 43 vote yesterday, the Senate confirmed Seema Verma as the next CMS Administrator, according to a New York Times article. Verma, the founder, president, and CEO of a health policy consulting firm, will be charged with managing...

CMS Reopens Next Generation ACO Application Request Portal

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Providers interested in joining the Next Generation Accountable Care Organization (ACO) model in 2018 can now access the Request for Applications and Letter of Intent on the program’s portal, according to a recent CMS announcement. The...

CMS Calls on Stakeholders for Pediatric APM Development Input

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CMS recently put out a request for information for a potential Medicaid and Children’s Health Insurance Program (CHIP) alternative payment model targeting pediatric care, according to an official CMS blog post. “Through the RFI [request...

NY Clinic Manager Pleads Guilty in $70M Medicare Fraud Scheme

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A New York-based healthcare clinic manager recently pled guilty for his role in a Medicaid and Medicare fraud ring involving three clinics across New York City. The scheme to defraud federal healthcare programs resulted in $70 million in fraudulent...

Former Tenet Exec Charged in $400M Healthcare Fraud Scheme

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The Department of Justice (DoJ) recently announced the indictment of Tenet Healthcare Corporation’s former senior vice president of operations for his alleged participation in a healthcare fraud scheme totaling over $400 million in inappropriate...

Beth Israel, Lahey Health Move Forward with Healthcare Merger

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Massachusetts-based Beth Israel Deaconess Medical Center and Lahey Health announced plans to pursue a healthcare merger earlier this week. The two healthcare systems have debated a potential merger since 2011, but the recent letter of intent...

CMS Reopens 2018 Next Generation ACO Model Applications

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Providers interested in participating in the Next Generation Accountable Care Organization (ACO) model in 2018 can now submit a letter of intent to CMS, according to the alternative payment model’s webpage. The Next Generation ACO model...

HHS, DoJ Recovered $3.3B From Healthcare Fraud Cases in 2016

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Through healthcare fraud cases and settlements in 2016, Department of Health and Human Services (HHS) and Department of Justice (DoJ) initiatives returned over $3.3 billion to the federal government and individuals, including $1.7 billion to...

359K Clinicians to Join CMS Alternative Payment Models in 2017

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CMS recently announced that the federal agency selected over 359,000 clinicians to participate in four of the federal agency’s alternative payment models in 2017. The new participants will be joining the Medicare Shared Savings Program...

Avoidable Hospitalizations Drop 31% for Long-Term Care Patients

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Avoidable hospitalizations among dual-eligible long-term care facility residents dropped by 31 percent between 2010 and 2015 largely because of value-based care programs, CMS recently stated in an official blog post. “Family members want...

CMS Brings Integrated, Multi-Payer Claims Data Access to CPC+

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In an official blog post, CMS recently touted its success with improving primary care provider productivity by giving practices in the Comprehensive Primary Care (CPC) program more multi-payer claims data access. The Medicare primary care program...

Court Denies HHS Wish to Nix Medicare Appeals Backlog Timeline

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A federal court recently denied a Department of Health and Human Services (HHS) request to reconsider the four-year timeline developed to eliminate the Medicare appeals backlog at the administrative law judge level. HHS projected the backlog...

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