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

Revenue Cycle Management Healthcare News

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...

Healthcare Prices, Spending, Employment Decline in Early 2017

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Recent research from the Altarum Institute showed that healthcare prices, spending, and employment are all trending downward after a three-year period of healthcare spending acceleration. Healthcare employment growth declined by 10,000 per month...

Seeing PCP As Main Provider Lowered Medicare Spending by 9%

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Using a primary care provider versus a specialist as the predominant provider of care and care coordination resulted in similar clinical outcomes for Medicare beneficiaries. But Medicare spending was $1,781 lower per beneficiary, a recent Journal...

AHA to IRS: Foster Hospital Participation in Commercial ACOs

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The American Hospital Association (AHA) recently called on leaders from the Department of Treasury and IRS to issue formal guidance that would permit non-profit hospitals to participate in commercial accountable care organizations (ACOs) without...

Top 4 Patient Financial Responsibility Collection Methods

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The top priority for providers is to deliver high-quality healthcare services to their patients. But the recent rise in patient financial responsibility and healthcare consumerism has forced some providers to bump patient collections to the top...

52% of Provider Compensation Bonuses Tied to RVUs, Not Quality

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Approximately 52 percent of provider compensation offers with a production bonus in 2017 based the additional pay on relative value units (RVUs), while just 39 percent used quality metrics, a recent Merritt Hawkins survey found. The study of...

Patient Engagement Critical to Bundled Payment Model Success

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Under bundled payment models, healthcare providers take on the clinical and financial risk payers traditionally managed. But providers at OrthoCarolina found that patients also play a major role in improving care quality and decreasing healthcare...

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