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

Reimbursement News

HHS Proposes Changes to Medicare Reimbursement Appeals Process

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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,...

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