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

Revenue Cycle Management Healthcare News

State Reviews Beth Israel, Lahey Health Hospital Merger

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The proposed hospital merger between Boston health systems Beth Israel Deaconess and Lahey Health is delayed as the state’s Health Policy Commission reviews the deal for healthcare costs, quality, and care access issues, according to local...

60% of Federal Revenue to Come from Risk-Based Models by 2019

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Almost 60 percent of federal revenue and 37 percent of commercial revenue will stem from risk-based models by 2019, according to a new AMGA survey. The survey of 74 AMGA medical groups uncovered that Medicare and Medicaid fee-for-service revenue...

Healthcare RCM, Medicare Reimbursement Dominate 2017 Stories

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From the Quality Payment Program’s launch to the Affordable Care Act debate, the healthcare finance world saw an abundance of change and uncertainty in 2017. In the face of payment reform and political debates, healthcare leaders focused...

How CMS Improves Primary Care Payments Through Codes, APMs

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New medical billing codes for non-face-to-face encounters and alternative payment models are trying to change the way Medicare reimburses for primary care, according to researchers at the Urban Institute’s Health Policy Center. The report,...

High-Risk Patient Management Did Not Drive Early ACO Cost Savings

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Care coordination and care management strategies focused on high-risk and chronically ill patients did not drive early cost savings among accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP), a recent Health Affairs...

GAO Offers Steps to Enhance Medicaid, Medicare Fraud Strategy

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CMS demonstrates a commitment to preventing and combating Medicaid and Medicare fraud, but the federal agency’s anti-fraud efforts only partially align with the Government Accountability Office’s (GAO) Framework for Managing Fraud...

Predictive Analytics Improve Nursing Schedules, Saving Mercy $4.3M

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Even with 40,000 physicians, nurses, and other employees, St. Louis-based Mercy Health still relied on staffing agencies and employee incentives to fill critical nursing schedule gaps until a predictive analytics platform helped operations leaders...

CAQH CORE Opens Certification for Electronic Prior Authorization

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CAQH’s Committee on Operating Rules for Information Exchange (CAQH CORE) recently opened the certification process for Phase IV operating rules, which include standard rules for the electronic exchange of administrative data, such as prior...

Advocate, Aurora and Dignity Health, CHI Sign Hospital Merger Deals

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The healthcare market in Chicago is bracing for some major changes starting with the recently announced hospital merger between Advocate Health Care and Wisconsin-based Aurora Health Care. The largest health system in Illinois revealed its intentions...

Key Capabilities for Value-Based Reimbursement Models

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Rising healthcare costs, shrinking reimbursement rates, and federal policies are driving hospitals and health systems to adopt value-based reimbursement, according to a new American Hospital Association (AHA) report. But the models are not one-size-fits-all...

ED Spending Increases 85% As Hospitals Code for More Severe Cases

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Emergency department spending per member rose 85 percent between 2009 and 2015 primarily because of hospitals coding and billing for a greater number of high severity cases, new Health Care Cost Institute (HCCI) data revealed. Spending on high...

VA Next Gen Healthcare Supply Chain Program Needs Work, GAO Says

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The Government Accountability Office (GAO) recently found several issues with the VA’s implementation of a next generation healthcare supply chain management program. The federal watchdog argued the implementation process failed to follow...

Physician Compensation at Non-Academic Hospitals Up to $123K More

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Physician compensation at non-academic hospital systems was almost $123,000 more than the amount paid to physicians in academic systems, a new Medical Group Management Association (MGMA) survey showed. The 2017 DataDrive Physician Compensation...

High-Value Culture, Population Health Programs Key to ACO Success

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Creating a high-value culture, engaging in proactive population health management, and implementing an infrastructure that promotes continuous performance improvement were key characteristics of 11 successful accountable care organizations (ACOs)...

Private Payer A/R, Denials Performance Troubles Hospital Revenue

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Small differences in private payer performance on claims reimbursement and denials can challenge hospital revenue cycles, a new Crowe Horwath analysis of five major commercial managed care payers uncovered. “Many providers focus their attention...

Nearly One-Third of Providers Dissatisfied with Healthcare Costs

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Almost one-third of providers are dissatisfied with the healthcare costs their patients pay for care, according to a recent survey from the University of Utah Health. The national survey of 5,031 patients and 687 physicians revealed that providers...

Collaboration Key to Independent Physicians in Value-Based Care

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At first glance, value-based care models appear to work against independent physicians. The risk-based arrangement requires a coordination of services across care continuum — primarily between primary care physicians and specialists but...

CMS Cancels Mandatory Hip, Cardiac Bundled Payment Models

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CMS recently finalized proposals to eliminate mandatory hip fracture and cardiac bundled payment models slated to launch on Jan. 1, 2018 and decrease the scope of the existing Comprehensive Care for Joint Replacement (CJR) bundled payment initiative....

Family Physicians Slowly Embracing Value-Based Reimbursement

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Slightly more family physicians are actively pursuing value-based reimbursement opportunities compared to two years ago despite persistent barriers, Humana and the American Academy of Family Physicians (AAFP) recently announced. The survey of...

Medical Billing Codes Do Not Address Full Scope of Primary Care

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Current Procedural Terminology (CPT) codes used for medical billing did not account for all the care provided by primary care physicians in about 60.3 percent of visits, a recent Journal of the American Board of Family Medicine study showed....

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