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

Claims Reimbursement

Reps Eye Delay for Medicaid Disproportionate Share Hospital Cuts

by Jacqueline LaPointe

Three House Representatives recently called on their Congressional peers to postpone implementing a rule that would reduce Medicaid Disproportionate Share Hospital (DSH) payments starting on Oct. 1, 2017. The bipartisan letter from...

EFT Flaws, Paper Enrollment Key Electronic Claims Management Issues

by Jacqueline LaPointe

Electronic claims management adoption continues to face challenges related to healthcare Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA), a new Workgroup for Electronic Data Interchange (WEDI) white paper...

AHA Questions Accuracy of Combined Post-Acute Care Payment System

by Jacqueline LaPointe

CMS and the Office of the Assistant Secretary for Planning and Evaluation (ASPE) should address fundamental issues with the prototype of a combined Medicare post-acute care payment system, a recent Dobson DaVanzo & Associates report...

HHS Offers Special Medicare Reimbursement After Hurricane Irma

by Jacqueline LaPointe

In the wake of Hurricane Irma, HHS re-opened the National Disaster Medical System (NDMS) Definitive Care Reimbursement Program, a special Medicare reimbursement program that ensures hospitals and other medical facilities receive payment...

17% of Practices Pay Fees for Electronic Healthcare Payments

by Jacqueline LaPointe

Approximately 17 percent of physician practices are forced to pay a fee for receiving electronic healthcare payments from their payers, with fees ranging between 2 and 5 percent of the total reimbursement, a recent MGMA poll of over 900...

Does the Medicare Physician Fee Schedule Undervalue Primary Care?

by Jacqueline LaPointe

CMS continues to put the revenue of primary care providers at risk by undervaluing codes for primary care and failing to meet the misvalued code target required by law in the proposed 2018 Medicare Physician Fee Schedule update, the...

CMS Offers Value-Based Purchasing Exceptions After Hurricane Harvey

by Jacqueline LaPointe

  Providers practicing in areas affected by Hurricane Harvey will not have to report to several Medicare and Medicaid quality reporting and value-based purchasing programs, CMS recently announced in...

AHA: New Skilled Nursing Facility Payment System Needs Development

by Jacqueline LaPointe

The American Hospital Association (AHA) recently urged CMS to flesh out a proposal to implement an alternative Medicare reimbursement model for skilled nursing facilities prior to advancing the changes through official rulemaking...

Advisory Group Warns CMS Against 340B Medicare Reimbursement Cuts

by Jacqueline LaPointe

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...

CMS Cancels Medicare Billing Changes for Partial Hospitalizations

by Jacqueline LaPointe

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...

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

by Jacqueline LaPointe

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...

Post-Acute Care Payment Reform Threatens Rural Hospitals

by Jacqueline LaPointe

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...

Court to Reconsider Timeline for Medicare Appeals Backlog End

by Jacqueline LaPointe

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...

Hospitals Turning to Staff Buyouts to Reduce Healthcare Costs

by Jacqueline LaPointe

Massachusetts-based Brigham and Women’s Hospital may extend a voluntary buyout offer to employees in order to reduce healthcare costs in the face of growing labor expenses and stagnant claims reimbursement rates. In April 2017, the...

Medicare Reimbursement Add-On to Boost Palliative Care Revenue

by Jacqueline LaPointe

A recent study in the Journal of Palliative Medicine showed that providers should be leveraging a supplemental Medicare reimbursement to enhance palliative care in the last seven days of life. CMS pays providers for furnishing routine...

CMS Ups Medicare Reimbursement for Inpatient Admissions $2.4B

by Jacqueline LaPointe

Medicare reimbursement updates and other payment policy changes finalized in a new rule from CMS will boost inpatient hospital payments by $2.4 billion in 2018 and decrease long-term care hospital payments by $110 million. “This...

Medicaid Reimbursement Woes Key Concern for Healthcare CEOs

by Jacqueline LaPointe

Approximately 85 percent of healthcare executives identified shrinking Medicaid reimbursement rates and funding as a top concern in 2017, according to a new Deloitte survey. Deloitte surveyed 20 CEOs from health systems that collectively...

Skilled Nursing Facilities See $370M Medicare Reimbursement Bump

by Jacqueline LaPointe

Skilled nursing facilities are slated to receive a 1 percent increase in Medicare reimbursement in 2018, representing $370 million more dollars in healthcare payments, CMS recently announced in a final rule. While CMS finalized Medicare...

MSSP ACOs Missed $886M in Potential Revenue By Avoiding Risk

by Jacqueline LaPointe

Accountable care organizations (ACOs) in Track 1 of the Medicare Shared Savings Program (MSSP) could have received an additional $886 million in net payments in 2015 if the organizations took on downside financial risk and earned the 5...

Hospital Orgs Oppose Site-Neutral Medicare Reimbursement Cuts

by Jacqueline LaPointe

Several hospital groups recently spoke out against proposed 2018 Medicare reimbursement updates that would reduce site-neutral payments to off-campus provider-based departments from 50 percent of the outpatient rate to 25 percent. CMS...

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