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

Claims Reimbursement

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...

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...

X

Join 30,000 of your peers and get free access to all webcasts and exclusive content

Sign up for our free newsletter:

Our privacy policy


no, thanks

Continue to site...