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

Revenue Cycle Management Healthcare News

Surveys Reveal MACRA Implementation, QPP Knowledge Lacking

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Two recent surveys indicated that healthcare provider and executive knowledge of and readiness for MACRA implementation and the Quality Payment Program are lacking despite the value-based reimbursement program launching in January 2017. A new...

Payer Collaboration Key to Value-Based Reimbursement Strategy

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Value-based reimbursement arrangements come in a myriad of shapes and sizes much like provider organizations. But successful value-based contracts will align provider and payer goals for care quality and healthcare utilization as well as establish...

68% of Consumers Did Not Pay Patient Financial Responsibility

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About 68 percent of patients with medical bills of $500 or less did not fully pay their patient financial responsibility to hospitals in 2016, according to a recent TransUnion Health study. The proportion of individuals failing to pay off full...

Industry Orgs Back 2018 MACRA Implementation Flexibilities

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Healthcare industry organizations largely applauded the recently-released 2018 MACRA implementation proposal from CMS. The medical organizations commended the federal agency’s continuation of the transition year into 2018 as well as the...

Implementing Value-Based Healthcare Revenue Cycle Management

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To align healthcare revenue cycle with value-based reimbursement, healthcare organizations should start by breaking down clinical and financial siloes established by fee-for-service payment models, agreed presenters at Xtelligent Media’s...

$262B of Total Hospital Charges in 2016 Initially Claim Denials

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Approximately 9 percent of hospital charges in 2016 were initially claim denials, according to a new Change Healthcare study. As a result, $262 billion out of $3 trillion in claims submitted last year was denied. The analysis of over 3.3 billion...

Exploring Quality Measures Under Value-Based Purchasing Models

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CHICAGO – Jason Goldwater, MPA, MA, Senior Director of the National Quality Forum, recently likened the value-based purchasing transition to the evolution of music at Xtelligent Media’s Value-Based Care Summit in Chicago. Music started...

Hospital Execs Look to Operations to Control Healthcare Costs

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With 78 percent of hospital leaders stating that rising healthcare costs are their primary concern in 2017, the leaders agreed that reviewing and optimizing existing operational and clinical processes was the hospital’s top strategy for...

CMS Proposes 2018 Quality Payment Program Changes

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CMS recently announced a proposed rule that would modify MACRA’s Quality Payment Program during its second performance year to ease provider burdens and continue to ramp up full participation in the program. A major proposed change would...

Do Financial Benchmarks Truly Measure ACO Savings, Spending?

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Healthcare stakeholders should not use financial benchmarks developed by CMS to evaluate actual accountable care organization (ACO) savings, three Harvard Medical School experts in a recent Health Affairs blogpost. As Medicare ACOs grow in popularity,...

Limited Healthcare Payment Incentives Challenge Care Management

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Misaligned healthcare payment incentives topped the list of challenges providers and payers faced when implementing effective care management programs under Medicare Advantage plans with capitated payments, a recent Robert Graham Center for Policy...

Care Standardization Key to Healthcare Revenue Cycle Excellence

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To be named a top health system by Truven Health Analytics and IBM Watson Health, it takes a range of clinical quality improvements and healthcare revenue cycle efficiencies. But for St. Luke’s Health System, one of 15 top health systems...

ACOs Restructure Healthcare Staffing for High-Risk Patients

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To successfully lower healthcare costs while improving care quality, accountable care organizations (ACOs) have restructured their healthcare staffing models to provide additional support to high-risk patients, a recent American Journal of Accountable...

MedPAC Eyes Merit-Based Incentive Payment System Redesign

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The Medicare Payment Advisory Commission (MedPAC) recently advised Congress to redesign MACRA’s newly-launched Merit-Based Incentive Payment System (MIPS) by eliminating MIPS measures, replacing them with population health measures, and...

Oncology Care Model Overcomes Specialty Bundled Payment Hurdles

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Episode-based payment models aim to shift financial accountability to providers for furnishing services for specific conditions or procedures. But develop specialty bundled payment models that target clinical areas, such as oncology, have proven...

Targeting Skilled Nursing Facility, ESRD Care Saves ACO $15M

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A Medicare Shared Savings Program (MSSP) accountable care organization (ACO) realized over $15 million in healthcare savings between 2014 and 2015 by improving skilled nursing facility utilization and targeting end-stage renal disease care, a...

96% of Healthcare Execs Report Rise in Inpatient Drug Spending

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Approximately 64 percent of healthcare executives reported that inpatient drug spending at their organization significantly increased over the past five years, a recent Premier Inc survey revealed. Another 32 percent said that it somewhat...

Optimizing RCM During Value-Based Reimbursement Transition

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Value-based reimbursement revolutionized how providers get paid for care delivery. However, the slow push away from fee-for-service payments has challenged providers looking to optimize healthcare revenue cycle management. To advance healthcare...

AHA Calls For 25% Rule End for Fair LTCH Medicare Reimbursement

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The American Hospital Association (AHA) pressed CMS Administrator Seema Verma to reconsider proposed Medicare reimbursement provisions for long-term care hospitals (LTCHs). Specifically, the industry group called for a permanent end to the 25-Percent...

Provider Collaboratives Combat Healthcare Merger Pressures

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Value-based reimbursement continues to drive healthcare merger and acquisitions activities. But hospitals and health systems can remain independent and achieve healthcare cost reduction and value-based reimbursement goals by joining a provider...

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