Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid
  • Value-Based Reimbursement Reduces Costs 15.6%, Improves Quality

    November 14, 2018 - Value-based reimbursement models are moving the needle on quality and cost, a new analysis from Humana shows. In 2017, medical costs for patients attributed to primary care practices (PCPs) in Humana’s value-based reimbursement models for Medicare Advantage (MA) were 15.6 percent lower compared to Medicare fee-for-service, the insurer reported. Internally, medical costs were...

  • 5% of MIPS Eligible Clinicians Earn a Negative Payment Adjustment

    November 9, 2018 - Approximately 93 percent of eligible clinicians participating in MACRA’s Merit-Based Incentive Payment System (MIPS) in 2017 earned a positive payment adjustment, CMS Administrator Seema Verma recently reported. “These results demonstrate that clinicians who engaged early and meaningfully participated experienced success,” the CMS leader stated in the official blog...

  • Exploring Changes to the Quality Payment Program in 2019

    November 6, 2018 - The final 2019 Medicare Physician Fee Schedule (PFS) rule contained a number of changes to evaluation and management (E/M) payment rates, site-neutral payments, and remote patient monitoring coverage. But the rule also included key MACRA implementation rules for the Quality Payment Program’s third year. According to CMS, the Medicare Access and CHIP Reauthorization Act of 2015...

  • CMS Delays Collapsing of E/M Payment Rates Until 2021

    November 1, 2018 - CMS will collapse evaluation and management (E/M) payment rates, but not until the 2021 calendar year, according to the recently released final 2019 Physician Fee Schedule (PFS) rule. After industry pushback, the federal agency will delay the implementation of a single, blended payment rate for E/M office/outpatient visit levels 2 through 4 for established and new patients. The PFS...


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NP, PA Office Visits Grow 129%, But Healthcare Costs Still Rising

Office visits to primary care physicians dropped 18 percent from 2012 to 2016 among non-elderly adults with employer-sponsored healthcare coverage, the Health Care Cost Institute (HCCI) recently reported. “The decline in primary...

Consumers Seek Care in New Settings for Lower Healthcare Costs

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Hospitals Want Practice Management Systems to Work with EHR, RCM

Hospitals are seeking customizable practice management systems that integrate with their revenue cycle management and EHR systems, according to a new survey from Black Book Research. Thirty-six percent of hospital system executives said...

Value-Based Reimbursement Reduces Costs 15.6%, Improves Quality

Value-based reimbursement models are moving the needle on quality and cost, a new analysis from Humana shows. In 2017, medical costs for patients attributed to primary care practices (PCPs) in Humana’s value-based reimbursement...

CMS Paid $4M in Excess GME Medicare Reimbursement, OIG Finds

Audits performed by the HHS Office of Inspector General (OIG) showed that hospitals received excess Graduate Medical Education (GME) Medicare reimbursement after counting residents and interns as more than one full-time equivalent...

AHA: Tariffs on Chinese Goods Will Impact Hospital Supply Chain

The American Hospital Association (AHA) recently opposed the Trump Administration’s tariffs on medical equipment and products imported from China, arguing the tariffs would impact the hospital supply chain. “The imposition of...

Court Orders HHS to Eliminate Medicare Appeals Backlog by 2022

HHS must eliminate the Medicare appeals backlog at the Administrative Law Judge (ALJ) level by the end of the 2022 fiscal year, according to a recent court order. Judge James E. Boasberg of the US District Court for the District of...

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