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

Revenue Cycle Management Healthcare News

Healthcare Disruption Spurs Hospitals to Alter Business Operations

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Eighty-five percent of hospital and health system executives believe the industry is at significant risk for healthcare disruption, and their organizations are preparing their business operations for potential changes to how healthcare...

Hospitals Seek Value-Based Contracting in Healthcare Supply Chain

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Nearly three-quarters of hospital and health system leaders are interested in value-based contracting in the healthcare supply chain, but opportunities to secure contracts with suppliers are lacking, a new survey from Premier Inc....

Atrium Health Settles Anticompetitive Hospital Contracting Claims

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Atrium Health in North Carolina recently agreed to a settlement with the Department of Justice (DoJ) and the North Carolina Office of Attorney General that prohibits the health system from using anticompetitive hospital contracting terms...

Partners, Harvard Pilgrim Suspend Healthcare Merger Talks

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Partners HealthCare, the largest hospital system in Massachusetts, recently halted healthcare merger talks with local insurer Harvard Pilgrim Health Care over concerns the deal would not earn regulatory approval. “Now isn’t...

Investing in Primary Care Delivers Value-Based Care Results

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Supporting primary care will bring value-based care results, asserts Humana’s Chief Medical Officer Roy Beveridge, MD. Value-based arrangements between providers and payers have the lofty, yet admirable goals of improving care...

Medicare Improper Payment Rate Down to 8.12%, Lowest Since 2010

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CMS recently reduced the Medicare improper payment rate as well as the improper payment rates for Medicaid and the Children’s Health Insurance Program (CHIP) for the first time in reporting history, the head of the federal agency...

NP, PA Office Visits Grow 129%, But Healthcare Costs Still Rising

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Office visits to primary care physicians dropped 18 percent from 2012 to 2016 among non-elderly adults with employer-sponsored healthcare coverage, the Health Care Cost Institute (HCCI) recently reported. “The decline in primary...

Consumers Seek Care in New Settings for Lower Healthcare Costs

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Consumers are generally comfortable with seeking routine care in healthcare settings beyond the hospital or their doctor’s office if the healthcare costs are lower, data from PwC’s Health Research Institute (HRI) showed. For...

Hospitals Want Practice Management Systems to Work with EHR, RCM

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Hospitals are seeking customizable practice management systems that integrate with their revenue cycle management and EHR systems, according to a new survey from Black Book Research. Thirty-six percent of hospital system executives said...

Value-Based Reimbursement Reduces Costs 15.6%, Improves Quality

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Value-based reimbursement models are moving the needle on quality and cost, a new analysis from Humana shows. In 2017, medical costs for patients attributed to primary care practices (PCPs) in Humana’s value-based reimbursement...

CMS Paid $4M in Excess GME Medicare Reimbursement, OIG Finds

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Audits performed by the HHS Office of Inspector General (OIG) showed that hospitals received excess Graduate Medical Education (GME) Medicare reimbursement after counting residents and interns as more than one full-time equivalent...

AHA: Tariffs on Chinese Goods Will Impact Hospital Supply Chain

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The American Hospital Association (AHA) recently opposed the Trump Administration’s tariffs on medical equipment and products imported from China, arguing the tariffs would impact the hospital supply chain. “The imposition of...

Court Orders HHS to Eliminate Medicare Appeals Backlog by 2022

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HHS must eliminate the Medicare appeals backlog at the Administrative Law Judge (ALJ) level by the end of the 2022 fiscal year, according to a recent court order. Judge James E. Boasberg of the US District Court for the District of...

Price Not the Only Driver of High Healthcare Costs, Research Shows

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Healthcare costs in Colorado are significantly higher compared to other states in the country. A recent analysis by the Network for Regional Healthcare Improvement (NHRI) showed that total cost of care in Colorado was 19 percent higher...

92% of Providers Concerned About Hospital Price Transparency Rule

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Ninety-two percent of healthcare providers are concerned about the new hospital price transparency requirement recently finalized by CMS, a new poll shows. CMS finalized the hospital price transparency requirement in the 2019 Inpatient...

5% of MIPS Eligible Clinicians Earn a Negative Payment Adjustment

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Approximately 93 percent of eligible clinicians participating in MACRA’s Merit-Based Incentive Payment System (MIPS) in 2017 earned a positive payment adjustment, CMS Administrator Seema Verma recently reported. “These results...

CMS Commits to Modernizing Medicare Billing for Office Visits

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Finalizing the consolidation of Medicare billing codes for evaluation and management (E/M) outpatient and office visits is the first step for CMS as the federal agency modernizes the payment structure for office visits, CMS Administrator...

Hospital Bankruptcies Are On the Rise, Hitting Rural Areas Hard

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The healthcare industry experience more than 20 hospital bankruptcies since 2016, and about three-quarters of the distressed hospitals operated in rural areas, law firm Polsinelli recently reported. The Am Law 100 firm tracks Chapter 11...

Patient Leakage Costs Most Healthcare Facilities 10% of Revenue

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Healthcare organizations are losing revenue because they are failing to properly mange referrals and patient leakage, a new survey shows. Forty-three percent of over 100 executives recently surveyed by Sage Growth Partners for Fibroblast...

HRSA Proposes Earlier Start Date for 340B Price Transparency Rule

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HHS plans to move forward the implementation date of a long-delayed 340B price transparency rule that will stop drug manufacturers from overcharging hospitals for drugs purchased under the drug discount program. In a recent notice of...

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