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

Claims Reimbursement

Will Behavioral Economics Improve Alternative Payment Models?

by Jacqueline LaPointe

Alternative payment models may need to account for the behavioral economics behind provider prescribing habits to effectively reduce healthcare costs from expensive medications and treatments, a recent American Journal of Managed Care...

Medicare Appeals Backlog Delays Decision Process By 4.5 Years

by Jacqueline LaPointe

Hospitals waited an average of 1,663.3 days, or a little over 4.5 years, to conclude the Medicare reimbursement audit and appeals process because of the extensive Medicare appeals backlog, a recent Journal of Hospital Medicine study...

3 Best Practices for Hospital Claim Denials Management

by Jacqueline LaPointe

Healthcare cost control continued to top hospital priority lists in 2017. But hospital leaders may be leaving millions of dollars on the table because of inefficient claim denials management processes. Claim denial rates ranged between...

AMGA: Align Medicare Reimbursement, Measures for High-Value Care

by Jacqueline LaPointe

AMGA recently called on CMS to align quality measures with spending performance as well as Medicare reimbursement policies across Medicare Advantage, fee-for-service models, and accountable care organizations (ACOs). In two letters to CMS...

CMS Suggests Hospital Medicare Reimbursement Policy Changes

by Jacqueline LaPointe

CMS recently suggested changes to Medicare reimbursement policies for hospital admissions and long-term care hospital stays as well as several recommendations for other Medicare value-based purchasing programs. The proposed rule released...

TN Law Aims to Make Payer Contract Management More Predictable

by Jacqueline LaPointe

Earlier this week, Tennessee Governor Bill Haslam signed the Provider Stability Act into law, which intends to increase transparency and accountability for payer contract management. Effective Jan. 1, 2019, the law will require payers in...

CMS Pauses Home Health Pre-Claim Review Demonstration

by Jacqueline LaPointe

CMS recently halted the home health Pre-Claim Review demonstration in Illinois for 30 days and the program will not expand to Florida as expected in April 2017, according to the federal agency’s website. “After March 31, 2017,...

AMGA Supports 15% Limit for Medicare Advantage Encounter Data

by Jacqueline LaPointe

AMGA recently applauded CMS for further reducing the percentage of encounter data to be used to determine Medicare Advantage enrollee risk scores from 25 percent in the proposed rule to 15 percent in the final 2018 performance year...

AHA: Post-Acute Care Medicare Reimbursement Reform Needs Time

by Jacqueline LaPointe

Later this month, the Medicare Payment Advisory Commission (MedPAC) plans to vote on a draft recommendation to Congress that would accelerate the development and implementation of a unified Medicare reimbursement system for four post-acute...

Oncologist Org Opposes MedPAC Medicare Reimbursement Changes

by Jacqueline LaPointe

The Community Oncology Alliance (COA) recently expressed concerns that proposed Medicare reimbursement changes for Part B services from the Medicare Payment Advisory Commission (MedPAC) would drive cancer care to more higher-cost...

MedPAC Targets Post-Acute Care for Healthcare Payment Reform

by Jacqueline LaPointe

In its March 2017 report to Congress, the Medicare Payment Advisory Commission (MedPAC) pinpointed post-acute care for healthcare payment reform after Congressional and CMS inaction resulted in as much as $11 billion in lost savings since...

Using Bundled Payments to Pay Providers for mHealth Nudges

by Jacqueline LaPointe

Many providers have been able to extend their reach outside of their office by using mHealth technologies that encourage patients to improve their own health outcomes through nudges. However, payment structures for the healthcare...

Top 4 Claims Denial Management Challenges Impacting Revenue

by Jacqueline LaPointe

For most healthcare organizations, claim denials are a normal, if not a frequent, occurrence. While very few can boast that their denial rates are close to zero, many providers face a number of challenges with implementing an effective...

46% of Providers Unsure About Value-Based Purchasing Impact

by Jacqueline LaPointe

Value-based purchasing is not a new term for many providers, yet 46.4 percent of healthcare providers and leaders are still unsure how the shift away from fee-for-service payments will impact their revenue cycles, a recent Physicians...

274 Orgs Calls on CMS to Add Medicare Advantage Advanced APMs

by Jacqueline LaPointe

CMS should develop financial incentives comparable to those in the Quality Payment Program’s Advanced Alternative Payment Model (APM) track for providers who assume financial risk under Medicare Advantage plans, CAPG and 273 other...

NH Judge Rejects CMS FAQs Clarifying Medicaid DSH Payments

by Jacqueline LaPointe

A district court in New Hampshire recently prohibited CMS from enforcing two Frequently Asked Questions (FAQs) that clarified how private payer and Medicare reimbursements paid to hospitals for dually-eligible Medicaid patients would be...

AMGA Backs CMS Proposal to Limit 2018 Medicare Encounter Data

by Jacqueline LaPointe

The American Medical Group Association (AMGA) recently supported a CMS proposal to delay the increased use of encounter data to determine Medicare Advantage plan risk scores and claims reimbursement amounts. In a recent proposed rule, CMS...

65% of Organized Providers Paid Via Alternative Payment Models

by Jacqueline LaPointe

Nearly two-thirds of healthcare providers in some type of integrated employment model, such as integrated health networks, physical hospital organizations, accountable care organizations, and large medical groups, are primarily reimbursed...

Transradial, Same Day Discharge Cardiac Care Drops Costs by $3.7K

by Jacqueline LaPointe

From acute myocardial infarctions to coronary artery bypass grafts initiatives, recent Medicare bundled payment models have providers focusing more on reducing healthcare costs and improving care quality for a range of cardiac care...

Payer, Provider Dialogue Key to Prior Authorization Reform

by Jacqueline LaPointe

ORLANDO - Prior authorization reform has recently been a hot topic for many healthcare industry groups and it was no different at HIMSS17. To find out more about what providers and payers plan on doing to alleviate the administrative and...

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