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

Revenue Cycle Management Healthcare News

Home Health Owners Face Charges for Medicare Fraud, Upcoding

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The federal government filed a lawsuit against the two owners of Gateway Health Systems in Chicago for their involvement in a Medicare fraud scheme that cost the federal healthcare program millions, the Department of Justice recently announced....

Using EHR Systems, Supports to Aid MIPS Reporting, Boost Scores

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Delivering high-quality care is already a complicated process for healthcare providers. Understanding, as well as reporting, to MACRA’s Merit-Based Incentive Payment System (MIPS) has made the task even more complex, explained Brad J. Abrams,...

100+ Medical Orgs Want MACRA Implementation Flexibilities Extended

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Over 100 medical organizations recently called on House Representatives to extend MACRA implementation flexibilities that allow HHS leaders to gradually implement full program requirements. The flexibilities should go on for another three years....

382 Hospitals Earn Initial Reconciliation Payments Under CJR Model

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Out of approximately 800 hospitals required to participate in Medicare’s Comprehensive Joint Replacement (CJR) model, 382 facilities will receive a reconciliation payment based on cost savings and care quality, according to preliminary...

2017 Hospital Merger Activity Likely to Beat 102 Deals in 2016

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Healthcare organizations engaged in 87 hospital merger and partnership transaction so far in 2017, a recent Kaufman Hall analysis showed. The most recent data revealed that 29 hospital merger and partnership deals were announced in the third...

Hospital Mergers Take Two or More Years to Produce Cost Savings

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Hospital mergers and acquisitions resulted in immediate decreases in operating expenses per adjusted admission. However, acquired facilities also saw operating revenue decline at a higher rate, leading to falling operating margins for the first...

61% of Next Generation ACOs Earned Shared Savings in 2016

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The majority of Next Generation Accountable Care Organizations (ACOs) earned shared savings in the first year of the model, recent data from CMS revealed. Eleven of 18 total Next Generation ACOs will receive a shared savings payment from CMS,...

Tenet Starts Chicago Market Exit with Sale of MacNeal Hospital

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Tenet Healthcare Corporation recently announced that Loyola Medicine has signed a definitive agreement to purchase MacNeal Hospital, one of Tenet’s four hospitals in the Chicago area. Loyola Medicine, an affiliate of Trinity Health, will...

Provider Data Integrity Key to Directory Accuracy, Value-Based Care

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Providers and their payers oftentimes have a love-hate relationship. Payers boost the number of patients walking through physician office doors using provider directories as well as reimburse providers for treating those patients. But navigating...

AHA: OIG Hospital Audit Extrapolation Led to Excessive Claim Denials

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The American Hospital Association (AHA) recently urged CMS to reconsider its extrapolation approach when conducting Office of the Inspector General (OIG) hospital audits because the method leads to excessive repayment requests and claim denials....

$67.4B in Hospital Community Benefit Outweighs Tax Revenue Loss

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Non-profit hospitals and health systems delivered $67.4 billion in community benefit activities in 2013, representing a benefit 11 times greater than the value of the tax revenue forgone by the tax-exempt status of the healthcare organizations,...

Specialists Face 16% MIPS Payment Adjustment Swing Under Proposal

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Specialists could face up to a 16 percent value-based incentive payment or penalty under MACRA’s Merit-Based Incentive Payment System (MIPS) in 2018 if a proposed rule to include Medicare reimbursement for Part B drugs in the program is...

Healthcare Price Growth Hits Lowest Rate in About Two Years

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Healthcare price growth in August 2017 increased by just 1.2 percent compared to the previous year, reaching the lowest growth rate in nearly two years and only three-tenths above the lowest growth rate ever recorded by Altarum Institute’s...

AHA Supports Bundled Payment Cancellation, Voices MACRA Concerns

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Despite back the decision by CMS to cancel two bundled payment models and modify another, the American Hospital Association contends that the federal agency is moving a bit too quickly in shifting providers to value-based payment. According to...

MedPAC Calls for MIPS Repeal, Voluntary Program Replacement

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The Affordable Care Act isn’t the only health policy facing a call for repeal and replace. The Medicare Payment Advisory Commission (MedPAC) recently urged HHS to repeal MACRA’s Merit-Based Incentive Payment System (MIPS) and replace...

ACOs Plan to Move to Downside Financial Risk, Capitation Contracts

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Accountable care organizations (ACOs) are planning to enter downside financial risk arrangements, with 47 percent planning on entering a shared savings and losses contract and 38 percent pursuing capitation, uncovered a recent survey of 240 ACOs...

Does Where Freestanding EDs Operate Change Hospital Payer Mix?

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Freestanding emergency departments (EDs) may be altering the payer mix at the equivalent hospital-based facility because the freestanding EDs tend to be located in areas with greater household incomes and insured rates, stated a recent Health...

Physician Advisors Crucial to Navigating Reimbursement Rules

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When physicians are asked why they went into medicine, the classic response is that they wanted to help people. But as value-based reimbursement takes hold and clinical documentation demands increase, providers are finding that the business of...

77% of Leaders Say Their Provider Orgs Use Paper Patient Billing

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While over one-half (52 percent) of patients prefer to receive medical bills electronically, approximately 77 percent of providers still use paper-based patient billing methods, a recent MGMA and Navicure survey revealed. The survey of 761 executives...

Low-Cost, Low-Value Resource Use Drives $586M in Wasteful Spending

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Inexpensive low-value resource use resulted in over $586 million, or $9.09 per beneficiary per month, in unnecessary healthcare spending in Virginia, a new Health Affairs study showed. The total amount spent on low-cost, low-value resource use...

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