Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid
  • Maximizing MIPS Scores Through Chronic Disease Prevention

    October 17, 2018 - The healthcare industry is moving beyond a “sick care” system and shifting to chronic disease prevention to lower costs and improve quality. However, the healthcare payment system is just catching up to the preventative care trend. Fee-for-service perpetuates a sick care model in which providers get paid for treating an illness and delivering services. With payment...

  • 4 Hospital Business Models for Consumer-Centric Healthcare

    October 15, 2018 - When a member of Gurpreet Singh’s family broke his wrist, they didn’t go to a hospital emergency room or an academic medical. Instead, the family headed to an urgent care center to triage the situation and develop a care plan. That choice between going to the hospital or an urgent care center is exactly why hospital business models need to change in the current healthcare...

  • 3 Strategies to Minimize the Burden of Prior Authorizations

    October 8, 2018 - Prior authorizations, or prior approvals, are strategies that payers use to control costs and ensure their members only receive medically necessary care. The cost-control process requires providers to acquire advance approval from payers before delivering specific services or items for a patient. Payers are increasingly using prior authorizations to lower their costs and improve care...

  • Exploring Virtual Groups in the Quality Payment Program, MIPS

    October 4, 2018 - Virtual groups enable independent physicians and clinicians in small practices to participate in Medicare’s historic push to transition to value-based reimbursement: the Quality Payment Program. The Quality Payment Program, or QPP, aims to shift the industry away from fragmented fee-for-service payments to a system that reimburses clinicians based on the value of the care they...


Today's Top Stories

Hospitals Lagging with Healthcare Cost Transformation Efforts

Healthcare cost transformation is a top hospital and health system need. But less than one in five executives reported cost reductions of more than five percent in any priority area in the last year, a new Kaufman Hall survey...

Maximizing MIPS Scores Through Chronic Disease Prevention

The healthcare industry is moving beyond a “sick care” system and shifting to chronic disease prevention to lower costs and improve quality. However, the healthcare payment system is just catching up to the preventative care...

Telemedicine at Center of Billion-Dollar Healthcare Fraud Scheme

Law enforcement officials in Tennessee recently charged four individuals and seven companies involved in a $1 billion healthcare fraud scheme involving telemedicine services, according to details recently released by the Department of...

CMS to Extend Healthcare Price Transparency to Prescription Drugs

CMS is attempting to extend healthcare price transparency to prescription drugs. According to a recently proposed rule, drug manufacturers may have to start including the list price for the medications they advertise on television. As...

Senator Urges FTC to Investigate Hospital Contracting Practices

Senate Judiciary Committee Chairman Chuck Grassley (R-IA) recently called on the Federal Trade Commission (FTC) to investigate whether hospitals and payers in the US are deliberately engaging in anticompetitive hospital contracting...

4 Hospital Business Models for Consumer-Centric Healthcare

When a member of Gurpreet Singh’s family broke his wrist, they didn’t go to a hospital emergency room or an academic medical. Instead, the family headed to an urgent care center to triage the situation and develop a care...

Hospital Readmission Program Penalties Didn’t Raise Mortality Rates

The Hospital Readmission Reduction Program (HRRP) achieved a significant drop in readmission rates for Medicare patients hospitalized for pneumonia, acute myocardial infarction (AMI), and heart failure without bringing an increase of...

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