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

Reimbursement News

Integrated Community Oncology Practices Need Cost Efficiency


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...

Physician-Led ACOs Need Opportunities to Thrive


Many of the HIMSS15 educational sessions this week in Chicago offered valuable insight into the financial future of the healthcare industry. Farzad Mostashari, MD, ScM, Aledade Inc. Founder and CEO and former National Coordinator...

Value-Based Reimbursement: Humana CEO’s Payer Perspective


In a Tuesday morning keynote speech at the Healthcare Information and Management Systems Society’s (HIMSS’) annual HIMSS15 conference and exhibition conducted this week in Chicago, Bruce D. Broussard, CEO and President of Humana,...

CMS’ Open Payments Advance Revenue Cycle Transparency


Physicians and teaching hospitals across the healthcare spectrum will be buried in a numbers game come April 6, 2015 when The Centers for Medicare & Medicaid Services’ (CMS’) period of payment review for physicians begins. Open...

New WEDI Focus on Bundled Payments, Value-Based Initiatives


The Workgroup for Electronic Data Interchange (WEDI) recently announced its Payment Models Workgroup is forming a new project team committee – the Bundled Payments Taskforce – to more closely examine bundled payments and various value-based...

Does the Sustainable Growth Rate Mean Smarter Reimbursement?


Last week, the House of Representatives passed legislation that permanently repealed the Sustainable Growth Rate (SGR) formula and established an original reimbursement plan with fundamentally implemented value-based care incentives.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...

Quantify Denial Rates for Smooth Revenue Cycle Management


A hospital or medical practice’s ability to swiftly and economically process claims and quantify denial rates is critical to ensure smooth revenue cycle management and medical reimbursement. The ability to accurately predict reimbursement...

Bipartisan House Repeals Medicare SGR Before Senate Vote


There are possible new improvements to the Medicare Sustainable Growth Rate (SGR) payment system today as the bipartisan House of Representatives overwhelmingly passed the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2). This legislation...

March 26: Week That Was in Healthcare Fraud and Malpractice


Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility...

AHA Sees Reimbursement as an ICD-10 Implementation Challenge


Reimbursement is a key aspect that will play a big role by ICD-10 implementation as the Oct. 1, 2015 deadline approaches and speculation abounds as to the damaging financial effects an unsuccessful ICD-10 transition could have on healthcare practices...

ICD-10 Preparation Means Actively Protecting Revenue Stream


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...

Examining a Holistic Approach to Revenue Cycle Management


As healthcare continues to shift more of its focus on to the customer, a holistic approach to revenue cycle management requires addressing changing consumer behaviors. Providers experiencing an increasing array of reimbursement challenges seek...

Physicians Struggling with Consistency in ICD-10 Transition


ICD-10 implementation involves a complicated code conversion that physicians struggle to comprehend, and the mandated code change raises substantial financial concerns. spoke with Andrew Boyd, Assistant Professor of Biomedical...

Cost Management Effectively Optimizes Revenue Cycle Activity


Effective means for managing revenue cycle activity and optimization continue to evolve amidst the upcoming effects of ICD-10 implementation, the urgent push for mainstream mobile data processing, and a vigorous demand for bundled and capitated...

Electronic Transactions Could Save Healthcare Billions  


As the healthcare industry continuously eliminates paper-based administrative processes and pushes for mainstream electronic transactions, the possible result is essentially tens of billions in savings for the healthcare industry. If six routine...

Physician Compensation Models Need Value-Based Reimbursement


As the healthcare reimbursement shifts from volume to value progresses, many practices are actively reviewing their current compensation plans in connection to accountable care and similar models. Although physician employment was once convolutely...

How Can Practices Improve Claims Management, Reimbursement?


When medical practices cannot maximize revenue and scrub claims because they miss best practice benchmarks, they also miss valuable opportunities to optimize revenue cycle management (RCM). This is one of the findings of a recent NextGen RCM...

Attention to Point of Service Ups Provider Revenue


The piece of the revenue cycle puzzle involving provider revenue poses an innovative challenge for healthcare professionals and requires discussion and further addressing. Point of service is when practices, hospitals, and health systems first...

March 13: Week That Was in Healthcare Fraud and Malpractice


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...

What Considerations Do Alternative Payment Models Require?


As the direction of various payment models evolve, payers are focusing on a variety of focuses and objectives. Effective physician engagement may require a stronger focus on specialist engagement, especially in preparation for 2018’s transition...


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