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

Reimbursement News

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...

Medicaid Acceptance, Payment Rates Both on the Decline

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The issue of a widespread lack of Medicaid acceptance is ongoing and yet to be resolved. A short-lived increase in Medicaid payments to primary care physicians last year has not generated an increase in Medicaid acceptance. More intervention...

Telehealth Reimbursement Needed for its Growth, Advancement

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An increasingly digitalized healthcare system has experienced significant telehealth reimbursement changes — even within the past five years — as it becomes more routinely integrated. The snowballing demand for telehealth solutions...

King v. Burwell Opposition Means 9.3 Million Lose Subsidies

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The King v. Burwell case will be formerly addressed within the US Supreme Court on March 4, 2015. The Supreme Court will hear arguments regarding the Affordable Care Act’s (ACA) future implications and if the Internal Revenue Service will extend...

Telehealth Reimbursement Complications Paint a Vague Future

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Despite its overwhelming benefits for improved patient quality of life, reimbursement complication is a major negative aspect regarding teleheath’s evolving legislation limitations. Fluctuating definitions regarding location may affect expected...

Costly Aspects of an Overstretched Revenue Cycle Management

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It is imperative physicians adequately review all expected possible financial shortcomings within revenue cycle management to immediately improve long-term healthcare performance and pinpoint performance opportunities that are commonly ignored...

Focusing on esMD for Healthcare Revenue Cycle Optimization

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With such a high volume of requests for medical documentation each year, handling them efficiently is beneficial for those working toward healthcare revenue cycle optimization in the years to come. Claim review contractors receive over 1,000,000...

Health Insurers Increase Use of Value-Based Reimbursement

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As value-based reimbursement increases, more health insurance providers are increasing its focus. The push for value-based reimbursement strategies in the healthcare landscape has gained major steam over the last few months. The Department of...

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