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

Claims Reimbursement

AMA: Health Payers Lagging with Prior Authorization Reform

March 14, 2019 - Health payers have not made meaningful progress with prior authorization reform, the American Medical Association (AMA) recently argued following the release of their new physician survey. The national association recently surveyed 1,000 practicing physicians to gauge the healthcare industry’s progress with prior authorization reforms agreed upon in the “Consensus Statement...


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White House Proposes $845B in Medicare Spending Cuts

by Jacqueline LaPointe

President Trump’s budget proposal for the 2020 fiscal year is requesting a tightening of the purse strings for HHS, including $845 billion in Medicare spending cuts over the next decade. The budget proposal released March 11 by the...

5 Rural Hospitals Take on All-Payer Global Budgets to Boost Care

by Jacqueline LaPointe

Pennsylvania Governor Tom Wolf recently tapped the first five hospitals and five payers to participate in a new alternative payment model from the CMS Innovation Center that uses all-payer global budgets to support rural hospital...

Rethinking the Claims Clearinghouse Relationship Helps Hospitals

by Jacqueline LaPointe

A growing network of post-acute care hospitals based in Pennsylvania recently achieved a near perfect clean claims rate and uncovered $12 million in inappropriate payer denials after switching its claims clearinghouse vendor. Vibra...

Medicare Reimbursement Changes Coming for Kidney Care, Dialysis

by Jacqueline LaPointe

HHS is reexamining Medicare reimbursement structures in kidney care that encourage more dialysis center treatment, rather than home-based care or even transplants. HHS Secretary Alex Azar made the announcement at the sixth annual Kidney...

Skilled Nursing Facility 3-Day Rule Behind $84M in Improper Pay

by Jacqueline LaPointe

The Office of the Inspector General (OIG) estimates CMS improperly paid $84 million for post-acute care services that did not meet the skilled nursing facility (SNF) 3-day rule in a recent two-year period. In a new report, the federal...

More Outpatient Site-Neutral Payments to Cut Costs, Coalition Says

by Jacqueline LaPointe

Extending and establishing site-neutral payments for outpatient services is the key to lowering healthcare costs, a coalition of patient advocates, providers, payers, and employers recently told top policymakers. “Site neutral...

Hospital Cost Shifting Still Occurring in CO Despite Coverage Gains

by Jacqueline LaPointe

Despite higher Medicaid reimbursement, fewer uninsured individuals, and less uncompensated care costs, hospital cost shifting to commercial payers did not subside in Colorado. Those are the findings from a new draft report from the...

Bots Make Claim Status Inquiry More Efficient for Avera Health

by Jacqueline LaPointe

Robots in healthcare do not have to be large human-like machines that replace providers. But bots embedded in software applications can be a key tool for reducing the burden of mundane, common tasks, such as claim status inquiry. At least...

More Hospitals Sue HHS Over Outpatient Site-Neutral Payments

by Jacqueline LaPointe

Thirty-eight hospitals filed a lawsuit against HHS over a $380 million reduction in Medicare reimbursement to hospitals under a new outpatient site-neutral payment policy. The lawsuit alleges that HHS Secretary Alex Azar overstepped his...

Claims Management Automation Progresses, But Opportunities Remain

by Jacqueline LaPointe

Electronic claims management adoption by plans and providers is at or above 80 percent for three of the seven transactions analyzed in the most recent CAQH Index. The CAQH 2018 Index showed adoption of fully electronic eligibility and...

40% of Revenue Cycle Leaders Don’t Discuss Charge Capture Regularly

by Jacqueline LaPointe

Over three-quarters (78 percent) of revenue cycle leaders at acute care organizations agreed charge capture is essential to an organization’s success, yet most leadership teams only discuss charge capture once a month or less. Those...

Medicare, Medicaid Reimbursement $76.8B Under Hospital Costs

by Jacqueline LaPointe

The largest public payers continue to underpay hospitals, data from the most recent American Hospital Association (AHA) Annual Survey of Hospitals revealed. Medicare and Medicaid reimbursement fell $76.8 billion short of the actual costs...

Hospitals Weigh in on Medicare DSH Payment Supreme Court Case

by Jacqueline LaPointe

Major hospitals and medical colleges recently urged the Supreme Court to affirm a DC Circuit Court decision that HHS violated the Medicare Act when the department altered the reimbursement adjustment formula for Medicare disproportionate...

Specialists Fear IPI Drug Pricing Model Could Harm Patient Access

by Jacqueline LaPointe

A healthcare industry group representing more than 7,700 rheumatologists and rheumatology health professionals recently warned the Trump Administration that its proposed International Pricing Index (IPI) drug pricing model for Medicare...

HHS Overstepped Authority with 340B Reimbursement Cuts, Judge Rules

by Jacqueline LaPointe

A federal judge in Washington DC recently struck down a nearly 30 percent reduction in 340B reimbursement cuts. US District Judge Rudolph Contreras ruled that HHS Secretary Alex Azar exceeded his statutory authority by issuing a policy...

Key Providers, Payers Tie 47% of Business to Value-Based Payment

by Jacqueline LaPointe

A large group of major healthcare payers and health systems are reporting that nearly half of their business rests in value-based payment arrangements. The Health Care Transformation Task Force (Task Force) is a group of leading...

New Medicare Reimbursement for Lab Tests May Overpay by Billions

by Jacqueline LaPointe

A new Medicare reimbursement system for clinical laboratory tests could increase spending for the public healthcare program by over $11 billion by 2020, a new Government Accountability Office (GAO) report shows. The federal watchdog found...

AHA, AAMC Sue HHS Over Site-Neutral Payment Expansion

by Jacqueline LaPointe

The American Hospital Association (AHA), Association of American Medical Colleges (AAMC), and three healthcare organizations are suing HHS over a new site-neutral payment policy slated to take effect on January 1, 2019. The site-neutral...

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