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

Features

Understanding the Quality Payment Program’s Advanced APM Track

From bundled payments to accountable care organizations, alternative payment models (APMs) are not new to healthcare providers. But the final MACRA implementation rule created a new subset of Advanced APMs, which could bring providers more revenue under the Quality Payment Program. Eligible clinicians in the Quality Payment Program have two participation options: the Merit-Based Incentiv...


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Exploring Two-Sided Financial Risk in Alternative Payment Models

As value-based care becomes the name of the game in healthcare, public and private payers are pushing providers to take on more financial accountability for their services through alternative payment models. In a fee-for-service world, providers received reimbursement for every test or procedure they performed without being penalized or rewarded if their services impacted patient outcome...

Top Revenue Cycle Management Vendors and How to Select One

As value-based reimbursement models, such as the upcoming Quality Payment Program, break down the walls between care quality and healthcare payments, more providers have set their sights on implementing vendor-sponsored revenue cycle management solutions that can manage the integration of reimbursement and value. The healthcare revenue cycle management software and services industry is p...

What a Trump Presidency Means for Value-Based Care and the ACA

Love it or loathe it, the United States is headed for four years of drastic policy changes under a Donald Trump administration, giving lawmakers another good chance to repeal, replace, or revise the Affordable Care Act. The landmark healthcare legislation was the centerpiece of one of the most contentious campaigns in American history.  Staring down anticipated premium hikes of up t...

How to Maximize Revenue with Improved Claims Denials Management

Claims denials may be a part of life for healthcare revenue cycle managers, but a prevention-focused denials management strategy may be able to significantly reduce the number of times billing staff are faced with unpaid claims. Recent healthcare reforms, such as reporting-heavy value-based reimbursement models, an updated ICD-10 coding system, and lower payment rates, have made it even ...

CMS Timelines for Stage 3 Meaningful Use, MACRA Implementation

For Medicare providers, CMS has set the pace for quality improvements and healthcare payment reform through Stage 3 Meaningful Use and the Quality Payment Program (under MACRA implementation). The programs are designed to put providers on track to achieve healthcare reform and innovation by applying payment incentives or penalties associated with program participation. Providers should b...

Understanding the Value-Based Reimbursement Model Landscape

In January 2015, the Department of Health and Human Services (HHS) announced that it intends to link half of all traditional Medicare payments to a value-based reimbursement model by the end of 2018.  The announcement, followed quickly by the unveiling of the MACRA framework that focuses on alternative payment models (APMs) for quality care improvements, led many providers...

Key Ways to Boost Collection of Patient Financial Responsibility

Ever since the Affordable Care Act was passed in 2010, more providers are experiencing a shift in healthcare revenue sources, especially as patient financial responsibility increases. While hospitals and physician practices traditionally communicated with a small group of payers to collect the majority of payments, providers are now seeing patients becoming more accountable for their hea...

Preparing the Healthcare Revenue Cycle for Value-Based Care

Not only do value-based care models aim to make healthcare providers more accountable for the services they provide to patients, but they are also designed to shift financial accountability away from payers to healthcare organizations. However, many providers are left wondering how to align their healthcare revenue cycle management strategies with value-based reimbursement arrangements. ...

What Is Healthcare Revenue Cycle Management?

While hospitals, small practices, and larger healthcare systems are known for saving lives and treating patients, every healthcare organization needs to develop successful processes and policies for staying financially healthy. That is where healthcare revenue cycle management comes in. Healthcare revenue cycle management is the financial process that facilities use to manage the adminis...

What Is Value-Based Care, What It Means for Providers?

Value-based care is a form of reimbursement that ties payments for care delivery to the quality of care provided and rewards providers for both efficiency and effectiveness. This form of reimbursement has emerged as an alternative and potential replacement for fee-for-service reimbursement which pays providers retrospectively for services delivered based on bill charges or annual fee sch...

Using Revenue Cycle Analytics for Effective Value-Based Care

The hospital industry has been experiencing a number of challenges in recent years due to the payment reforms coming from the Centers for Medicare & Medicaid Services (CMS) and commercial health payers. There has been a much greater push toward value-based care reimbursement and away from fee-for-service payment programs. This has led to the development of bundled payment contracts, ...

What We Know About Value-Based Care Under MACRA, MIPS, APMs

The Medicare Access and CHIP Reauthorization Act of 2015 has many parts tied to Medicare and other federal health plan beneficiaries, but first and foremost it is a bill that brings an end to the sustainable growth rate and a beginning to new incentive programs for providers working in a value-based care ecosystem.* *NB. HHS recently announced the publishing of the proposed rule for MACR...

Key Ways to Improve Claims Management and Reimbursement in the Healthcare Revenue Cycle

Reimbursement is changing in healthcare. Even before elements of the Affordable Care Act began to go into effect, a growing focus on value- based care versus volume has led many healthcare organizations and providers to consider accountable and patient-centered care models in which they assume a greater share of risk. In this changing climate, revenue must be managed differently to ...

Why Healthcare Needs Value-Based Supply Chain Management

Healthcare supply chain — the holistic flow of relationships between suppliers and customers — is about efficiently delivering low cost care as goods and supplies, such as a pair of doctor’s gloves, move from point of purchase to point of use. A reported one-third of hospital decision makers believe their hospital supply chain is functioning at maximum efficiency, but t...

How to Design a Comprehensive EHR Usability Assessment

EHRIntelligence A decade after the HITECH Act of 2009 first incentivized EHR adoption, many physicians remain dissatisfied with EHR design and are seeking improvements to EHR usability. Optimizing an EHR so that it offers intuitive, streamlined workflows is imperative for promoting clinical efficiency and reducing provider burden. Shortening the amount of time clinicians spend sifting through patient da...

Using Community Paramedicine, mHealth for Care Coordination at Home

mHealthIntelligence Community paramedicine programs offer hospitals and health systems an opportunity to leverage mHealth to reduce emergency department costs and improve care management for patients with complex chronic diseases. Mobile Integrated Health Community Paramedic (MIH-CP) programs are often rooted in partnerships with local EMS and ambulance companies. They deploy specially trained paramedics to...

As Artificial Intelligence Matures, Healthcare Eyes Data Aggregation

HealthITAnalytics It hasn’t taken very long for artificial intelligence to become the most popular topic of conversation in the world of healthcare data analytics.  In what seems like an instant, AI has started to support incredible advances in imaging analytics, clinical decision support, operational efficiencies, and patient engagement. Algorithms can now identify anomalies, make suggestions,...

Patient Engagement Strategies for Improving Patient Activation

PatientEngagementHIT Clinical care is only one step along the path to helping a patient achieve her optimal state of health.  While cutting-edge procedures and innovative therapeutics play a critical role in treating or managing diseases, they typically can’t produce the best possible outcomes on their own. Patients must be engaged and activated to participate in their own care in order for clinic...

CMS Sparks Mixed Reactions with Interoperability, Data Blocking Rules

HealthITAnalytics CMS and the ONC dropped a moderate bombshell on the healthcare industry this week by releasing their information blocking and interoperability proposals on the eve of HIMSS19. A conference that typically focuses on forward-thinking innovation suddenly became a time to revisit past mistakes, forcing vendors and providers to reexamine their role in creating and maintaining the walled garde...

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