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

Revenue Cycle Management Healthcare News

Exploring Key Components of the Healthcare Revenue Cycle


The healthcare revenue cycle encompasses “all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue,” according to the Healthcare Financial Management Association...

New Medicare Fraud Audits to Ease Burden on Compliant Providers


CMS recently updated its Medicare fraud and improper payment audit process to target providers and suppliers who continually demonstrate high medical billing error rates, according to the federal agency’s website. The new Targeted Probe...

Real-Time Data for Denials Management Aids Practice’s Lagging A/R


Without transparency throughout the claim denials management process, healthcare organizations are leaving a significant portion of potential revenue on the table. Limited access to timely claim denial and reimbursement data can prevent providers...

Post-Acute Care Payment Reform Threatens Rural Hospitals


A proposed unified Medicare reimbursement for post-acute care services and value-based care payment models, such as accountable care organizations (ACOs) and bundled payments, may propel rural hospital closures as the reforms lower their post-acute...

Court to Reconsider Timeline for Medicare Appeals Backlog End


The DC appeals court recently revoked the court-ordered elimination timeline for the current $6.6 billion Medicare appeals backlog, arguing that the previous court was in error of the law by requiring HHS to do away with the backlog despite the...

Top 10 Enterprise Resource Planning (ERP) Vendors By Hospital Use


Healthcare providers have become increasingly interested in implementing enterprise resource planning (ERP) systems as part of their business intelligence and revenue cycle management suites. ERP systems are business management tools that give...

Accountable Care Organization Saves $4.8M With Nutrition Aid


A case study in American Health & Drug Benefits showed that Advocate Health Care, an accountable care organization in the Chicago area, reduced healthcare costs by $3,800 per patient, or $4.8 million in total, by implementing a nutrition...

CMS May Cancel Upcoming Cardiac, Ortho Bundled Payment Models


UPDATE: CMS released the complete proposed rule, which would cancel the Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model. The proposed rule would also decrease the number of mandatory geographic regions in the Comprehensive...

Quality Payment Program, MIPS Top 2017 Regulatory Burden List


Medicare’s new value-based reimbursement program has topped the list of most burdensome regulations for healthcare providers, according to a new MGMA survey. About 82 percent of leaders from 750 group practices viewed MACRA’s Quality...

Physician Expert, Clinical Documentation Key to MIPS Success


Since the Obama administration signed MACRA into law in 2015, healthcare providers have been attempting to understand the Quality Payment Program and its Merit-Based Incentive Payment System (MIPS). But regular updates and tweaks to MACRA have...

Small Health System Achieves ROI with Asthma Management Clinic


Asthma is one of the most expensive chronic diseases for providers, payers, and patients. But a recent study in the American Journal of Managed Care showed that a stationary pediatric asthma management clinic can achieve a return on investment...

25% of Physicians Dissatisfied with Provider Compensation Rates


Even though a majority of physicians either received the same or an increase in provider compensation in 2016, about one-quarter of them expressed dissatisfaction with their annual pay last year, a recent PraticeMatch survey revealed. The survey...

Health Center Work Conditions Drop After Practice Transformation


Improving work conditions for clinicians and staff members may be key to implementing practice transformations for value-based care in federally qualified health centers (FQHCs), a new Health Affairs study suggested. Recent survey results showed...

NYC Health’s ERP System to Bring Business Ops to Digital Age


From payroll and workload management to orders and purchasing, health systems manage a myriad of back-end business operations, using a combination of automated systems as well as manual processes associated with each function. The web of disparate...

Hospitals Turning to Staff Buyouts to Reduce Healthcare Costs


Massachusetts-based Brigham and Women’s Hospital may extend a voluntary buyout offer to employees in order to reduce healthcare costs in the face of growing labor expenses and stagnant claims reimbursement rates. In April 2017, the hospital...

Medicare Reimbursement Add-On to Boost Palliative Care Revenue


A recent study in the Journal of Palliative Medicine showed that providers should be leveraging a supplemental Medicare reimbursement to enhance palliative care in the last seven days of life. CMS pays providers for furnishing routine home care...

Patient-Reported Data Helps Providers Find High-Cost Patients


Self-reported patient data on health conditions, status, and utilization may be the key to identifying high-cost patients and guiding them to care management models to reduce their spending, a recent American Journal of Managed Care study indicated....

Primary Care Job Growth Slows, Affecting Healthcare Spending


With the number of specialist jobs rising nearly six times faster than primary care provider positions between 2005 and 2015, industry efforts to control and reduce healthcare spending may be in trouble, a recent Health Affairs blogpost suggested....

CMS Ups Medicare Reimbursement for Inpatient Admissions $2.4B


Medicare reimbursement updates and other payment policy changes finalized in a new rule from CMS will boost inpatient hospital payments by $2.4 billion in 2018 and decrease long-term care hospital payments by $110 million. “This final rule...

Top 4 Rural Hospital Challenges with Revenue Cycle Management


Rural hospitals may be the only healthcare option for individuals living in sparsely populated areas, but revenue cycle management challenges have forced many of these facilities to permanently close their doors. The healthcare industry has seen...


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