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

Reimbursement News

GAO: Drug Couponing Affecting Medicare Reimbursement Rates


The methodology for calculating Medicare reimbursement to providers for prescription drugs under the Part B program may be contributing to higher Medicare spending because it does not account for the impact of coupon programs, according to recent...

AHA: Delay Site-Neutral Rule to Address Medicare Fraud Risks


The American Hospital Association (AHA) has asked CMS to delay the implementation of proposed site-neutral payments for another year because the payment reform rule could increase a hospital’s Medicare fraud and abuse risks. Site-neutral...

AHA Critiques Medicare Reimbursement Changes for Home Health


The American Hospital Association (AHA) is urging CMS to delay outlier provisions and streamline certain medical billing procedures proposed in a recent document aimed at home health facilities. In June, CMS released a proposed rule that would...

Providers Save Healthcare Costs via Medication Adherence


Developing chronic disease and population health management programs is key to achieving value-based care, but a new study in the American Journal of Managed Care found that the programs themselves must also be cost-effective to maximize reductions...

How Emergency Providers Can Adopt Alternative Payment Models


With many value-based care initiatives aiming to reduce costly emergency room visits, some emergency departments are finding it increasingly difficult to engage with alternative payment models, according to a report in the American Journal of...

Team-Based Primary Care Cuts FFS Healthcare Revenue by 2.5%


As healthcare providers continue to transition to value-based care, many hospitals and physician practices have focused on how to improve care coordination and team-based approaches to improve patient outcomes and boost their healthcare revenue...

Driven by Specialists, Physician Compensation Rates Rise 3.1%


Physician compensation has increased by 3.1 percent in 2015, according to a recent survey from the American Medical Group Association (AMGA). The rate represents a 0.3 percent increase from last year. “Once again this year, we see that...

Providers in Iowa Face Medicaid Claims Reimbursement Delays


After privatizing the Medicaid program in April, some healthcare providers in Iowa have experienced serious delays in Medicaid claims reimbursement that have caused some organizations to consider shutting their business doors. According to Chelsea...

Cerner to Increase Focus on Value-Based Reimbursement


Cerner has named Adventist Health System's Jeff Hurst to oversee its revenue cycle management division, the company announced Tuesday. Hurst, who currently serves as Florida Hospital's Senior Vice President of Finance at Florida Hospital...

Understanding the Basics of Bundled Payments in Healthcare


The shift to value-based care has driven public and private payers to redesign reimbursement models that stress accountability for care quality and healthcare costs. As the fee-for-service environment fades away, alternative payment models like...

Payment Reform Incentives Influence Physician Decision-Making


Some patients are finding that financial incentives under Medicare payment reform rules have caused their providers to focus more on boosting healthcare revenues rather than improving patient outcomes. According to a recent study in The American...

Would Proposed Value-Based Reimbursements Reduce Drug Costs?


Spending on prescription drugs has been a major pain point for all stakeholders in the industry. But could value-based reimbursement models for certain drugs under Medicare Part B be the answer to rising drug costs? According to a Health Affairs...

HHS Proposes Changes to Medicare Reimbursement Appeals Process


Earlier this week, the Department of Health & Human Services (HHS) released a notice of proposed rulemaking (NPRM) to modify the Medicare reimbursement appeals process in efforts to reduce the substantial backlog of unresolved appeals. “The...

Industry Group Advises HHS to Expand Bundled Payment Models


The Center for American Progress (CAP), a Washington think tank, has called on the federal government to expand bundled payment models in order to further reduce healthcare costs and advance value-based care. The letter to Department of...

Ambulatory Surgery Centers Help Reduce Healthcare Costs


With a push for more healthcare transparency, more beneficiaries are now equipped to reduce healthcare costs by selecting the cheapest option for medical services. However, some providers may not be as lucky since site of care can create significant...

How to Address Challenges of Alternative Payment Models


As the healthcare industry moves towards value-based care, more providers are choosing alternative payment models to facilitate the transition. CAPG, a trade association of accountable physician organizations, has published a guide of alternative...

Survey: Value-Based Reimbursement to Eclipse FFS by 2020


As federal agencies and commercial payers push to eliminate fee-for-service payment models, value-based reimbursement structures have been on the top of most healthcare provider and payer agendas. The majority of healthcare providers and payers...

GAO: Backlog Persists for Claims Reimbursement Appeal Process


Discovering that a claim has been denied is hard enough, but the appeals process that manages claims reimbursement disputes may be even harder to handle for most healthcare providers. According to a recent report from the Government Accountability...

Managing the Revenue Cycle while Acquiring Physician Practices


Since 2010, hospital and health systems have been adapting their care delivery models to meet health reform requirements. At the forefront of this effort is physician practice acquisition. An analysis of healthcare provider acquisitions in the...

CMS Allows Some ACOs to Join New Value-Based Care Model


CMS has expanded the eligibility requirements in the Comprehensive Primary Care Plus (CPC+) model to include primary care physicians in certain Medicare accountable care organizations (ACOs), according to an updated fact sheet. Up to 1,500 primary...


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