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

Revenue Cycle Management Healthcare News

MACRA Implementation, Healthcare Consumerism Trends at HIMSS17

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As healthcare stakeholders are packing their bags for the upcoming HIMSS17 conference in sunny Florida, many are expecting to learn about the hottest healthcare revenue cycle management topics from the past year. From MACRA implementation and...

52-47 Senate Vote Confirms Tom Price as New HHS Secretary

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Early this morning, the Senate approved Tom Price as the new Department of Health and Human Services (HHS) Secretary by a 52 to 47 vote, according to multiple sources. Price, a Republican representative from Georgia, will be the first provider...

HHS: Physician Self-Referral Law Hinders Value-Based Care

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Some healthcare fraud prevention regulations many impede value-based care models that use financial incentives to encourage providers to improve care quality and reduce healthcare costs, the Department of Health and Human Services (HHS) recently...

NY Clinic Manager Pleads Guilty in $70M Medicare Fraud Scheme

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A New York-based healthcare clinic manager recently pled guilty for his role in a Medicaid and Medicare fraud ring involving three clinics across New York City. The scheme to defraud federal healthcare programs resulted in $70 million in fraudulent...

AMA: Eliminate Prior Authorization for Opioid Abuse Treatment

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The American Medical Association (AMA) recently called on attorney generals across the nation to follow in New York’s footsteps with reforming prior authorization requirements for medication-assisted treatment for opioid abuse. New York’s...

Key Considerations for Bundled Payment Model Adoption, Success

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As the value-based reimbursement transition pushes on, many provider organizations have turned to bundled payment models as a stepping stone to alternative payment model adoption. “Bundled payments can be an organization’s first step...

Did Risk-Based APMs Propel Greater Provider Consolidation?

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A recent Health Affairs study revealed that risk-based alternative payment models, such as accountable care organizations (ACOs), have not spurred greater provider consolidation in the post-Affordable Care Act healthcare environment. Medicare...

How Radiologists Can Join an Advanced Alternative Payment Model

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Radiologists may want to look to the physician-focused payment model path in MACRA to develop specialty-specific Advanced Alternative Payment Models (APM), suggested a recent Journal of the American College of Radiology report. Harvey L. Neiman...

Hospital Costs Fall Despite Overall Healthcare Spending Growth

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Medicare spending growth on both inpatient and outpatient services hit an all-time low for the first time in 17 years, with inpatient hospital costs notably decreasing by 1.9 percent since 2015, the American Hospital Association (AHA) recently...

AMGA: Slow Encounter Data Transition in Medicare Reimbursement

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The American Medical Group Association (AMGA) recently commended CMS for decelerating the transition to using encounter data as a means for risk-adjusting Medicare reimbursement to Medicare Advantage organizations in 2018. In an announcement...

Former Tenet Exec Charged in $400M Healthcare Fraud Scheme

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The Department of Justice (DoJ) recently announced the indictment of Tenet Healthcare Corporation’s former senior vice president of operations for his alleged participation in a healthcare fraud scheme totaling over $400 million in inappropriate...

Healthcare Execs Ponder Financial Impact of Possible ACA Repeal

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With a possible full or partial Affordable Care Act repeal in the near future, healthcare executives called for some of the healthcare reform law’s provisions to continue, such as increased insurance coverage and the value-based reimbursement...

Maryland All-Payer APM Reduces Medicare Hospital Costs by $429M

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As the Maryland All-Payer alternative payment model starts its fourth year, a Health Affairs report shows that the program reduced Medicare hospital costs by $429 million, exceeding CMS requirements that the model save $330 million five years....

4 Key Ways to Boost Point-of-Service Patient Collections

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In a time of healthcare consumerism and high-deductible health plans, the patient has become a major revenue source for healthcare organizations. But without strong point-of-service patient collection strategies, providers could be seeing their...

GAO Finds $36B in Improper Medicaid Reimbursements in 2016

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Approximately $36 billion in Medicaid reimbursements made to providers and suppliers in 2016 were improper, a 9.8 percent increase from last year’s Medicaid improper payment amount, the Government Accountability Office (GAO) recently reported...

Group Purchasing Reduces Healthcare Supply Chain Costs Up to 15%

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In the first Annual Value Report, the Healthcare Supply Chain Association (HSCA) found that group purchasing organizations reduced healthcare supply chain costs by 10 to 15 percent for providers. Prescription drug spending also went down by up...

Beth Israel, Lahey Health Move Forward with Healthcare Merger

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Massachusetts-based Beth Israel Deaconess Medical Center and Lahey Health announced plans to pursue a healthcare merger earlier this week. The two healthcare systems have debated a potential merger since 2011, but the recent letter of intent...

More Orgs Transitioning to Full Physician-Hospital Integration

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The proportion of healthcare organizations that have full physician-hospital integration with physicians on salary grew from 44 percent in 2008 to 55 percent in 2013, a new Rice University’s Baker Institute for Public Policy report found....

Hospitals, Health Systems Eye Financial Snags in ACA Repeal

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In identical letters to the Trump Administration and Congress, the American Hospital Association and other state and regional associations are urging members of both branches of the federal government to continue working on legislation to...

Patient Care Navigation Program Reduces Cancer Care Costs

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Using non-physician and nurse providers as part of a patient navigation program can significantly lower healthcare costs and utilization for cancer patients while generating a return on investment, a recent JAMA Oncology study revealed. From...

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