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

Claims Reimbursement

Hospitals Wait 16 More Days for Late Payments from Claim Denials

May 7, 2018 - Delayed payments stemming from claim denials are significantly impacting hospital revenue cycles, taking an average 16.4 more days to pay compared to claims that have not been denied, a new analysis from Crowe Horwath revealed. The analysis of patient financial transactions in more than 850 hospitals showed that the cost and cash flow implications of claims denials that are eventually paid...


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CMS to Up Medicare Payments, Reduce Burdens for Inpatient Rehabs

by Jacqueline Belliveau

CMS is seeking to reduce the administrative burden for inpatient rehabilitation facilities on top of a proposed $75 million Medicare payments increase in the 2019 fiscal year. The federal agency released several proposed rules for post-acute...

CMS Proposes Patient-Driven Pay for Skilled Nursing Facilities

by Jacqueline Belliveau

CMS recently proposed updates to several post-acute care prospective payment systems, with skilled nursing facilities seeing a potentially new Medicare reimbursement arrangement, called the Patient Driven Payment Model. The Patient Driven Payment...

Rural Hospitals Get Low-Volume, Medicare-Dependent Funds Extended

by Jacqueline Belliveau

While the recent 2019 Medicare Inpatient Prospective Payment System (IPPS) rule brought major changes to healthcare price transparency and meaningful use, the rule also extended two key payment programs for small and rural hospitals. Those programs...

AMA, ASAM Create Alternative Payment Model for Opioid Use Disorder

by Jacqueline Belliveau

The American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) recently unveiled an alternative payment model that aims to improve care and reduce costs associated with opioid use disorder. The new alternative payment...

CMS Appeals Ruling on Changing Medicaid DSH Payment Rules in MO

by Jacqueline Belliveau

CMS is appealing a recent federal court decision that barred the agency from enforcing a 2017 final rule and two sub-regulatory articles from 2010 in Missouri. The federal agency stated that rule and articles clarified the formula for calculating...

MedPAC Suggests Cutting Medicare Reimbursement for Stand-Alone EDs

by Jacqueline Belliveau

The Medicare Payment Advisory Commission (MedPAC) recently voted to reduce Medicare reimbursement by 30 percent for off-campus stand-alone emergency departments (ED) in urban areas. The recommendation will be included in the commission’s...

Judge Asks AHA to Develop Medicare Appeals Backlog Solutions

by Jacqueline Belliveau

A federal judge is calling on the American Hospital Association (AHA) to recommend strategies to reduce the growing Medicare appeals backlog, a recent court order stated. According to the AHA’s website, US District Judge James Boasberg...

Medical Billing Complexity Highest for Medicaid Fee-for-Service

by Jacqueline Belliveau

Medical billing for Medicaid fee-for-service claims proved to be the most complex across all insurers. The public payer had a claims denial rate 17.8 percentage points greater than the rate for Medicare fee-for-service claims, a new Health Affairs...

Site-Neutral Medicare Reimbursement Too Low for LTCHs, AHA Argues

by Jacqueline Belliveau

Site-neutral Medicare reimbursement for long-term care hospitals (LTCHs) will cover less than half the actual costs of care for qualifying cases, the American Hospital Association (AHA) recently told CMS. The Bipartisan Budget Act of 2013 included...

Bringing Profee, Facility Together to Maximize Coding Productivity

by Jacqueline Belliveau

Professional and facility coding describe two very different aspects of a healthcare. But breaking down the wall between the departments has the potential to boost coding productivity and improve clean claim rates. While professional codes primarily...

92% of Docs Say Prior Authorizations Negatively Impact Outcomes

by Jacqueline Belliveau

Physicians are reporting that prior authorizations are negatively affecting patient care, a new American Medical Association (AMA) survey of 1,000 physicians showed. Ninety-two percent of primary care and specialty physicians who provide 20 or...

340B Hospitals Delivered $26B in Unreimbursed, Uncompensated Care

by Jacqueline Belliveau

Unreimbursed and uncompensated care costs were 27.4 percent higher at Disproportionate Share Hospitals (DSH) enrolled in the 340B Drug Pricing Program in 2015 compared to non-340B acute care hospitals, according to a new analysis from L&M...

CMS Guidance to Lower Claim Denials for Inpatient Rehab Facilities

by Jacqueline Belliveau

CMS recently clarified that contracted auditors should not give inpatient rehabilitation facilities claim denials solely because the services did not meet time-based therapy requirements. The guidance, which will go into effect on March 23, stated...

Judge Voids CMS Rule Altering Medicaid DSH Payment Calculations

by Jacqueline Belliveau

A US District Court for Washington DC recently vacated a CMS final rule from 2017 that required third-party payments, including those from Medicare, to be used when calculating hospital-specific limits on Medicaid Disproportionate Share Hospital...

AMA, Anthem Team Up to Streamline Prior Authorizations

by Jacqueline Belliveau

The American Medical Association (AMA) and Anthem, Inc. recently announced that they will work together over the next year to streamline prior authorization requirements and improve the healthcare experience overall through provider and payer...

AHA, Hospital Groups Renew Call to End 340B Drug Payment Cuts

by Jacqueline Belliveau

After a federal judge recently ruled that CMS can enforce cuts to 340B drug payments, the American Hospital Association (AHA) and 35 state and regional hospital associations resumed their efforts to end $1.6 billion in reimbursement reductions....

Slow and Steady Still the Motto for Value-Based Reimbursement

by Jacqueline Belliveau

The healthcare industry has boarded the train to value-based reimbursement. But recent roadblocks have provider organizations pumping the brakes with the shift away from fee-for-service, explained industry experts Doral Jacobsen, MBA, FACMPE,...

MO Court Bans CMS from Altering DSH Medicaid Reimbursement Rules

by Jacqueline Belliveau

A District Court in Missouri prohibited CMS from enforcing a 2017 final rule and two Frequently Asked Questions (FAQs) from 2010 that would alter the formula for calculating hospital-specific limits for  Medicaid reimbursement under the...

Hospital Cost-Shifting Increases Private Payer Payments by 1.6%

by Jacqueline Belliveau

Healthcare organizations that faced Medicare reimbursement reductions under the Affordable Care Act engaged in hospital cost-shifting that resulted in 1.6 percent higher average payments from private payers, a new working paper from the National...

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