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

Revenue Cycle Management Healthcare News

How Palomar Health Created a High-Value Post-Acute Care Network

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Ensuring patients receive high-value care delivery during their hospital stay or office visit is a top priority for healthcare providers. But value-based purchasing models are pressuring doctors to extend that same cost-efficient, high-quality...

Advisory Group Warns CMS Against 340B Medicare Reimbursement Cuts

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The CMS Advisory Panel on Hospital Outpatient Payment recently called on the federal agency to abandon proposed changes to the 340B Drug Pricing Program in 2018, which would reduce Medicare reimbursement to qualifying hospitals for drugs acquired...

Readmissions, Post-Acute Care Drive Variation in Bundled Payments

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Hospital readmissions, professional fees, and post-acute care payments are key drivers of cost variations for providers participating in 90-day cardiac bundled payment models, a recent JAMA Surgery study revealed. “These results underscore...

Scarce Public Health Funds Block Social Determinants of Health Aid

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As value-based care emphasizes preventative medicine, healthcare stakeholders aim to address social determinants of health to improve and maintain outcomes. But the lack of appropriate public health funding at federal, state, and local government...

In IRS First, Non-Profit Hospital Loses Status Under ACA Rules

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The IRS recently revoked a rural hospital’s non-profit status for failure to meet new community health needs assessment requirements under the Affordable Care Act. According to an IRS letter dated Feb. 14, 2017, the unnamed hospital lost...

Mixed APM Results Offer Lessons for Healthcare Payment Reform

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The verdict is still out on whether key alternative payment models, such as accountable care organizations (ACOs) and bundled payments, reduce healthcare costs and improve care quality. But the mixed results should not discourage the industry...

CMS Cancels Medicare Billing Changes for Partial Hospitalizations

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CMS revoked Medicare reimbursement changes to its medical billing requirements and process for partial hospitalization services, according to a recent Medicare Learning Network announcement. The federal agency originally introduced the Medicare...

Private Sector to Drive Bundled Payments After CMS Cancellations

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CMS recently announced its intention to modify its bundled payments strategy by proposing to eliminate forthcoming mandatory cardiac models and decreasing the scope of the Comprehensive Care for Joint Replacement (CJR) program. The pull away...

AMGA: MIPS Exclusion Rules Inhibit Value-Based Care Under MACRA

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The American Medical Group Association (AMGA) recently opposed several proposed changes to the Quality Payment Program and its Merit-Based Incentive Payment System (MIPS) for the 2018 performance period. The group particularly expressed concerns...

Cost Savings Unclear for Medicaid Alternative Payment Models

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Alongside Medicare and private payers, states are making the switch to value-based reimbursement, but states and independent researchers have yet to demonstrate the impact of Medicaid alternative payment models on healthcare costs and patient...

Exploring Key Components of the Healthcare Revenue Cycle

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The healthcare revenue cycle encompasses “all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue,” according to the Healthcare Financial Management Association...

New Medicare Fraud Audits to Ease Burden on Compliant Providers

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CMS recently updated its Medicare fraud and improper payment audit process to target providers and suppliers who continually demonstrate high medical billing error rates, according to the federal agency’s website. The new Targeted Probe...

Real-Time Data for Denials Management Aids Practice’s Lagging A/R

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Without transparency throughout the claim denials management process, healthcare organizations are leaving a significant portion of potential revenue on the table. Limited access to timely claim denial and reimbursement data can prevent providers...

Post-Acute Care Payment Reform Threatens Rural Hospitals

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A proposed unified Medicare reimbursement for post-acute care services and value-based care payment models, such as accountable care organizations (ACOs) and bundled payments, may propel rural hospital closures as the reforms lower their post-acute...

Court to Reconsider Timeline for Medicare Appeals Backlog End

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The DC appeals court recently revoked the court-ordered elimination timeline for the current $6.6 billion Medicare appeals backlog, arguing that the previous court was in error of the law by requiring HHS to do away with the backlog despite the...

Top 10 Enterprise Resource Planning (ERP) Vendors By Hospital Use

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Healthcare providers have become increasingly interested in implementing enterprise resource planning (ERP) systems as part of their business intelligence and revenue cycle management suites. ERP systems are business management tools that give...

Accountable Care Organization Saves $4.8M With Nutrition Aid

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A case study in American Health & Drug Benefits showed that Advocate Health Care, an accountable care organization in the Chicago area, reduced healthcare costs by $3,800 per patient, or $4.8 million in total, by implementing a nutrition...

CMS May Cancel Upcoming Cardiac, Ortho Bundled Payment Models

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UPDATE: CMS released the complete proposed rule, which would cancel the Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model. The proposed rule would also decrease the number of mandatory geographic regions in the Comprehensive...

Quality Payment Program, MIPS Top 2017 Regulatory Burden List

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Medicare’s new value-based reimbursement program has topped the list of most burdensome regulations for healthcare providers, according to a new MGMA survey. About 82 percent of leaders from 750 group practices viewed MACRA’s Quality...

Physician Expert, Clinical Documentation Key to MIPS Success

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Since the Obama administration signed MACRA into law in 2015, healthcare providers have been attempting to understand the Quality Payment Program and its Merit-Based Incentive Payment System (MIPS). But regular updates and tweaks to MACRA have...

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