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

Claims Reimbursement

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...

Hospitals, ASCs, 340B Drugs Face Medicare Reimbursement Changes

by Jacqueline LaPointe

CMS recently proposed a rule that would update Medicare reimbursement rates for hospitals and ambulatory surgical centers as well as change some prescription drug rates to 340B hospitals. Hospitals would see a 2 percent Medicare...

Provider Profitability Drops Under Biosimilar Use Reimbursement

by Jacqueline LaPointe

Biosimilar use could be the key to lowering healthcare costs associated with biologic treatments, but provider profitability may suffer by as much as $100 million across care settings if providers continue to administer the low-cost...

Proactive Healthcare Charge Integrity Captures Missed Revenue

by Jacqueline LaPointe

The key to a successful healthcare charge integrity initiative is the ability to trend chargemaster and coding data, stated Harriett Johnson, the Assistant Director of Revenue Integrity at Novant Health. The trending capability allows...

$262B of Total Hospital Charges in 2016 Initially Claim Denials

by Jacqueline LaPointe

Approximately 9 percent of hospital charges in 2016 were initially claim denials, according to a new Change Healthcare study. As a result, $262 billion out of $3 trillion in claims submitted last year was denied. The analysis of over 3.3...

Limited Healthcare Payment Incentives Challenge Care Management

by Jacqueline LaPointe

Misaligned healthcare payment incentives topped the list of challenges providers and payers faced when implementing effective care management programs under Medicare Advantage plans with capitated payments, a recent Robert Graham Center...

Optimizing RCM During Value-Based Reimbursement Transition

by Jacqueline LaPointe

Value-based reimbursement revolutionized how providers get paid for care delivery. However, the slow push away from fee-for-service payments has challenged providers looking to optimize healthcare revenue cycle management. To advance...

AHA Calls For 25% Rule End for Fair LTCH Medicare Reimbursement

by Jacqueline LaPointe

The American Hospital Association (AHA) pressed CMS Administrator Seema Verma to reconsider proposed Medicare reimbursement provisions for long-term care hospitals (LTCHs). Specifically, the industry group called for a permanent end to the...

86% of Providers Saw Prior Authorization Requirements Increase

by Jacqueline LaPointe

Approximately 86 percent of medical practice leaders reported that prior authorization requirements have increased over the past year, a recent MGMA survey of over 1,000 leaders found. Only 3 percent stated that prior authorization...

2016 Medicaid, Medicare Improper Payments Over Regulatory Cap

by Jacqueline LaPointe

A recent Office of the Inspector General (OIG) report revealed that the rates of Medicaid and Medicare improper payments in 2016 exceeded the legislative threshold of less than 10 percent. The improper payment rate for Medicare...

AHA Urges Rural, Post-Acute Care Medicare Reimbursement Reform

by Jacqueline LaPointe

In a Congressional hearing on the current status of Medicare reimbursement systems, the American Hospital Association (AHA) urged lawmakers to focus on rural hospital and post-acute care payments. MACRA extended a number of key Medicare...

Execs Say Value-Based Purchasing to Hit Tipping Point by 2020

by Jacqueline LaPointe

Over one-half (55 percent) of healthcare executives surveyed after the recent presidential election stated that the industry should reach the value-based purchasing tipping point before 2020, a recent Lazard report revealed. The survey of...

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