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

Revenue Cycle Management Healthcare News

CMS Proposes to Extend Site-Neutral Payments to Clinic Visits

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CMS recently proposed to implement site-neutral payments for clinic visits provided at off-campus provider-based hospital departments. According to a recently proposed CY 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS)...

Medical Liability Immunity Reduces Defensive Medicine, Costs by 5%

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A new working paper by the National Bureau of Economic Research shows that medical liability immunity can change how a provider practices medicine by decreasing defensive medicine use and its associated healthcare costs. Providers ordered...

340B Hospitals Provided Similar Charity, More Uncompensated Care

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The debate over whether 340B hospitals truly use discounted prescription drug rates to improve care for vulnerable, low-income patients goes on with a new Government Accountability Office (GAO) report. GAO found that the median amount of...

Hospital Employment, Medical Group Participation Increases in 2018

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Hospital employment is trending up, with 64 percent of medical professionals in a recent survey by the Medicus Firm reporting being employed by a hospital, medical group, or other healthcare facility in 2018. The percentage of employed...

Healthcare Revenue Higher for Practices Employing More NPs, PAs

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Primary care practices that employ more physician assistants, nurse practitioners, and other non-physician providers have greater healthcare revenue and productivity, the Medical Group Management Association (MGMA) recently reported. In...

Finding a Revenue Cycle Management System for Post-Acute Care

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Post-acute care has become a major focus as providers, payers, and policymakers attempt to cut healthcare costs and improve long-term patient outcomes. However, the revenue cycle management space is dragging its feet when it comes to...

Target Prices to Control Prescription Drug Spending, AHA Advises

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With prices, not utilization, driving prescription drug spending at hospitals and health systems, the American Hospital Association (AHA) recently called on policymakers to focus on controlling costs via average sales price (ASP)...

NY Health System Settles E&M Upcoding, Healthcare Fraud Case

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A New York-based health system will pay the federal government $14.7 million to settle healthcare fraud allegations that claim the system engaged in evaluation and management (E&M) upcoding. According to the Department of Justice...

Court Rejects AHA’s Attempt to Block 340B Hospital Payment Cuts

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A federal appellate court recently tossed the American Hospital Association’s (AHA) lawsuit against HHS, which attempted to block $1.6 billion in 340B hospital payment cuts. Three judges on the US Court of Appeals for the District...

Industry Orgs Fight Anthem’s Emergency Department Payment Policy

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The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) are suing Anthem’s Blue Cross Blue Shield (BCBS) of Georgia over a new policy that allows the payer to retroactively deny emergency...

Healthcare Cost Control Rises to Top Hospital Exec Priority

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Healthcare cost control rose to the top of hospital leader priority lists, bypassing revenue growth for the first time, according to the Advisory Board’s most recent Annual Health Care CEO Survey. The survey of 146 C-suite...

CMS Misses Chance to Move Physician Pay, QPP to Value, AMGA Says

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CMS recently proposed several changes to Medicare physician payments and MACRA’s Quality Payment Program to reduce medical billing and administrative burden. But initial reactions from medical group associations have not been...

Docs, Payer Execs Agree Providers Lack Tools for Value-Based Care

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A lack of technology and patient data may be stalling or even reversing the value-based care transition, a new survey of primary care physicians and health plan executives revealed. “Stalled Progress on the Path to Value-Based...

A Provider-Sponsored Health Plan Is A Hospital’s Natural Next Step

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Many hospitals and health systems are bypassing the ultimate opportunity to gain greater control of the outcomes and costs of their patients. That opportunity is developing their own provider-sponsored health plan, according to Geisinger...

Who Should be Held Accountable for Healthcare Costs?

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While the recent growth in patient financial responsibility has providers thinking about healthcare costs when making care decisions, many still do not think they should be held accountable for the costs of care, a recent survey showed. A...

Beth Israel, Lahey Health Hospital Merger May Up Costs, MA AG Says

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The proposed hospital merger between Beth Israel Deaconess Medical Center and Lahey Health is facing pushback from the Massachusetts Attorney General despite a previous endorsement from a key state board. Local news sources are reporting...

CMS Proposes 2019 Physician Payment, Quality Payment Program Changes

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CMS recently proposed major changes to Medicare physician payments and the Quality Payment Program to reduce the administrative burden of medical billing. The potential changes in the Medicare Physician Fee Schedule would save individual...

ESRD Orgs May See Higher Medicare Reimbursement, Drug Payments

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A new proposal from CMS would increase Medicare reimbursement to end-stage renal disease (ESRD) facilities by $220 million and change the way the federal agency pays the facilities for new renal dialysis drugs. The proposed update to the...

CMS OKs Medicaid Reimbursement for Substance Use Treatment in NH

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CMS recently approved a five-year Section 1115 demonstration allowing New Hampshire to provide Medicaid reimbursement to more behavioral health facilities for substance use disorder treatment services. The approval authorizes the Granite...

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