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

Reimbursement News

Physicians Struggling with Consistency in ICD-10 Transition

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

Cost Management Effectively Optimizes Revenue Cycle Activity

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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  

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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

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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?

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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

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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

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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?

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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...

Affordable Care Act Means Lower Reimbursement for Physicians

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One year after The Affordable Care Act’s (ACA) implementation, most physicians urge Congress to overturn the legislation after experiencing lower reimbursement, as reported in a recent physician survey. Although 44 percent of surveyed physicians...

Many Denials, Rejections to Follow the ICD-10 Transition?

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After profuse speculation and ample delay, the deadline for the healthcare industry ICD-10 transition remains set for Oct. 1, 2015. As popular speculation of especially disastrous results prospers, it is feasible massive denials and rejections...

AMA President Urges Physicians Prepare for ICD-10 Transition

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A recent letter from the American Medical Association (AMA) and 99 other physician groups to the Centers for Medicare & Medicaid Services (CMS) expressed collective concern that effective contingency plans require further completion to prevent...

High Critical Access Hospital Reimbursement Costs Medicare

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Swing-bed services provided at 90 percent of critical access hospitals (CAHs) could have been avoided by use of neighboring alternative facilities during 2010, reports the Office of Inspector General (OIG). If swing-bed services at CAHs —...

Medicare Advantage Average Payment Cut Hurts Beneficiaries

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The Centers for Medicare & Medicaid Services (CMS) proposes to slash Medicare Advantage (MA) and Medicare Part D (MAPD) plan payments next year by an average payment cut of .95 percent, as stated in February’s 2016 Calendar Year (CY)...

What Steps Comprise the Life Cycle of a Medical Claim?

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Although reimbursement is a vital aspect within a claim’s life cycle, it is certainly not the only vital piece. It is important to recognize and distinguish each stage from the other within the total life cycle of a medical claim to decrease...

March 6: Week That Was in Healthcare Fraud and Malpractice

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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...

Does 2015 ICD-10 Transition Mean Millions in Unpaid Claims?

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A hundred physician groups, including the American Medical Association (AMA), expressed strong trepidation regarding the potential for a dangerous accumulation of millions of dollars in unpaid Medicare claims when the ICD-10 transition goes into...

Value-Based Care Transition Begins with Physician Engagement

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Physician engagement is the key to improving how the American healthcare system performs in 2015 in regards to a smooth value-based care transition, according to The Advisory Board Company’s Annual Health Care CEO Survey. Physician engagement...

GAO Recommends Changes to Medicaid Reimbursement Technology

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A new United States Government Accountability Office (GAO) survey of the Medicaid program integrity systems in ten nationwide areas found there is a substantial puzzle piece missing within the world of information technology (IT) and Medicaid...

ProMedica Details Successes in Supply Chain Management

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As the healthcare industry continues to advance and thrive, the most prominent organizations perpetually pursue effective supply chain management through the execution of three innovative methods: waste hindrance, money management, and enhancing...

Why Site Neutral Payment Reimbursements Are Incomparable

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Legislation is under review for site neutral payment reimbursements where identical reimbursement is offered for two starkly contrasting types of patient care and resources. Congress will possibly implement a Medicare Payment Advisory Commission...

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