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

Reimbursement News

How to Manage ACO Risk with Value-Based Purchasing Programs


The game of Risk is more than just a generally entertaining board game about world supremacy. It is also a critical game healthcare providers, payers, and hospital executives play daily regarding their own revenue cycle management objectives....

Twelve Things to Know Now About Value-Based Reimbursement


The healthcare industry continues to move away from fee-for-service and advance further into the realm of value-based care. But at what pace? Perhaps rather quickly. Some healthcare experts and leaders confirm an alleged hastening pace means...

Rural Hospitals Address Medicare Reimbursement Cut Concerns


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...

EHRs Advance Medicaid Reimbursement and Stabilize Insurance


The meaty 1,024 pages of the Affordable Care Act (ACA) call for the vast expansion of healthcare coverage, the active promotion of decreased healthcare costs, and enhanced quality care. In the midst of ACA expansion efforts, Medicare and Medicaid...

Next Generation Analytics Demand Actionable Results


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,...

ICD-10 Implementation: Five More Facts to Know Now


Last week, presented the top five facts to know now about ICD-10 implementation, as reported by the Centers for Medicare & Medicaid Services (CMS). Here are five (more) facts to know now, as announced by CMS. Knowledge...

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...


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