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

Reimbursement News

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...

Nonprofit Organizations Lead Way in Hospital Revenue Cycle


Profits in hospital revenue cycles for nonprofit health organizations were strong in 2013. That year, seven of the top 10 most profitable hospitals in the US were nonprofit facilities, according to a recent Health Affairs study. Each of the top...

Hospital Mergers, Acquisitions Bring Revenue Opportunities


Hospital mergers and acquisitions have been on the rise ever since the Affordable Care Act started to change the way the healthcare system generates its revenue. Throughout 2013, many major health systems consolidated to create multi-hospital...

AMA Releases Value-Based Care, MACRA Resources for Providers


As part of its STEPS Forward program, the American Medical Association (AMA) has released eight new educational modules to support healthcare providers with the transition to value-based care, reported AMA in an official press release. AMA has...

Why Claims Accuracy Testing, QA Isn’t Working for Healthcare


Let’s face it. Testing isn’t working.  That’s the hard truth about the healthcare industry and its track record on claims accuracy testing and quality assurance. The harder truth is that this problem is expensive –...

Rural Hospitals May Get Senate Help with Medicare Reimbursements


As the healthcare industry shifts from volume to value, hospitals are expected to provide quality care as many could also potentially face lower Medicare reimbursements. At the same time, many hospitals in rural and economically distressed areas...

Five Best Practices to Prepare for Value-Based Reimbursement


Accountable care organizations (ACO) hold the key to successfully implementing value-based care and receiving value-based reimbursement. However, delivering quality care while also preparing for value-based reimbursement is not a simple task....

Bundled Payments Program Extended to Improve Value-Based Care


The Centers for Medicare & Medicaid Services (CMS) recently announced that some healthcare organizations can extend their participation in the Bundled Payments for Care Improvement (BPCI) initiative, a program that aims to increase value-based...

Accountable Care Organization Savings Shift After First Year


More than 700 accountable care organizations (ACO) currently work toward the goal of improving the quality of healthcare while also reducing capital costs of healthcare thanks to the Affordable Care Act. Meanwhile, researchers attempt to figure...

41% of Providers, Payers Adopt Value-Based Care Reimbursement


With the push from private and commercial health payers along with federal agencies to adopt value-based care reimbursement strategies, many more healthcare providers seem to have begun contracting through pay-for-performance arrangements. A...

Defining the Top 10 Terms of Healthcare Revenue Cycle Management


In some cases, definitions for terms and acronyms related to healthcare revenue cycle management can come across as fairly straightforward. Other times, they can sound more like a foreign language. A healthcare professional may find it difficult...

Healthcare Orgs to Review Healthcare Costs on Open Payments


According to a recent blog post, CMS is offering healthcare providers a chance to review and dispute healthcare costs related to manufacturers and group purchasing organizations, which will be published on the Open Payments data website on June...

New Primary Care Model Embraces Value-Based Reimbursement


This week, CMS announced its largest multi-payer initiative to improve primary care and introduce new value-based reimbursement models. The Comprehensive Primary Care Plus (CPC+) model aims to help practices transition from the “one-size-fits-all,...

6 Steps for Safeguarding the Healthcare Revenue Stream


With the ICD-10 conversion behind us, most billing and coding hiccups caused by the transition are slowly becoming a distant memory. However, rising patient out-of-pocket expenses – expected to reach $420 billion in 2015 – are just...

Healthcare Supply Chain Management Fraud Still Runs High


Despite a growing reliance on monitoring technologies to prevent fraud, healthcare organizations are still struggling to combat theft and abuse when it comes to supply chain management. According to a new survey from Deloitte Financial Advisory...

Affordable Care Act Increases Spending For Newly Insured


As the Affordable Care Act (ACA) brings more patients into the healthcare system, spending is on the rise, especially on chronic diseases, such as diabetes, heart disease and depression. Blue Cross Blue Shield (BCBS) backs this point in a recent...

Cancer Costs Don’t Rise Faster than Other Healthcare Spending


Cancer-related healthcare costs have increased at almost the same rate as non-cancer healthcare spending since 2004, according to a recent study by Milliman and the Community Oncology Alliance. The study counteracts the common misbelief that...

How Value-Based Care Payment Improves Patient Outcomes


Last month, the Centers for Medicare and Medicaid Services (CMS) released a new value-based care payment system for Medicare Part B drug prescribing protocols of physicians. Medicare Part B is a program in which decisions are reimbursed for prescribing...

Acquisitions, Scale Key to Pediatric Revenue Cycle Management


Stanford Children’s Health may be best known for delivering expert acute care to pediatric patients and expectant mothers at the flagship Lucile Packard Children’s Hospital, but inpatient services are only a part of how the system...

How to Scale Healthcare Bundled Payments throughout Hospitals


Healthcare bundled payments are a key strategy across the industry aimed at boosting patient health outcomes, improving the quality of care, and bringing reimbursement toward a value-based payment model. While the Centers for Medicare & Medicaid...


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