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

Claims Reimbursement

AMGA: Slow Encounter Data Transition in Medicare Reimbursement

by Jacqueline LaPointe

The American Medical Group Association (AMGA) recently commended CMS for decelerating the transition to using encounter data as a means for risk-adjusting Medicare reimbursement to Medicare Advantage organizations in 2018. In an...

GAO Finds $36B in Improper Medicaid Reimbursements in 2016

by Jacqueline LaPointe

Approximately $36 billion in Medicaid reimbursements made to providers and suppliers in 2016 were improper, a 9.8 percent increase from last year’s Medicaid improper payment amount, the Government Accountability Office (GAO) recently...

Healthcare Groups Offer 21 Prior Authorization Improvements

by Jacqueline LaPointe

A coalition of 17 healthcare industry groups recently called on health plans, benefit managers, and other healthcare stakeholders to change prior authorization requirements to improve care continuity, reduce provider burdens, and improve...

HHS Finalizes Solutions to Decrease Medicare Appeals Backlog

by Jacqueline LaPointe

In effort to reduce the significant Medicare appeals backlog, the Department of Health and Human Services (HHS) recently finalized several appeals process changes. Major modifications included using precedential decision-making at the...

AAFP: Primary Care Undervalued in Medicare Reimbursement

by Jacqueline LaPointe

CMS released updated physician fee schedule rates in November 2016, but the American Academy of Family Physicians (AAFP) recently contended that Medicare reimbursement rates for primary care providers are still lacking. In a letter to...

Electronic Claims Management Adoption to Save Providers $7.9B

by Jacqueline LaPointe

Healthcare providers could save about $7.9 billion annually by switching to automated claims management processes, particularly for prior authorizations, remittance advices, and claim attachment submissions, according to the 2016 CAQH...

Addressing Social Risk in Medicare Value-Based Reimbursement

by Jacqueline LaPointe

Hospitals that disproportionately treat patients with social risk factors, such as low income and race, may be unfairly penalized under some Medicare value-based reimbursement programs. But the National Academies of Science, Engineering,...

AHA Calls for Medicare Reimbursement Bump for Hospital Services

by Jacqueline LaPointe

The American Hospital Association (AHA) recently urged the Medicare Payment Advisory Commission (MedPAC) to finalize a recommendation that would boost Medicare reimbursement for hospital inpatient and outpatient services in 2018. In a...

Drug Costs, Limited Claims Reimbursement Challenge Cancer Care

by Jacqueline LaPointe

Cancer care centers named high prescription drug costs and lack of claims reimbursement for supportive services as the top challenges associated with providing care in 2016, according to an annual Association of Cancer Care Centers (ACCC)...

How the 21st Century Cures Act Impacts Medicare Reimbursement

by Jacqueline LaPointe

The 21st Century Cures Act may have been a landmark law for precision medicine, drug innovation, telemedicine, and mental health reform, but the law also contained several Medicare reimbursement policy changes set to take effect starting...

OIG Finds Medicare Payment Problems with Two-Midnight Policy

by Jacqueline LaPointe

Hospitals may face more Medicare reimbursement audits on inpatient and outpatient claims after the Office of the Inspector General (OIG) recently found several vulnerabilities associated with the Two-Midnight policy. Using hospital and...

CMS Hinders Private Plan Steering for Claims Reimbursement Bump

by Jacqueline LaPointe

CMS recently released an interim final rule designed to prevent providers at Medicare-certified dialysis centers from inappropriately steering patients away from Medicare and Medicaid in order to get higher claims reimbursement rates under...

AMGA: Value-Based Reimbursement Transition Slower Than Expected

by Jacqueline LaPointe

Fee-for-service revenue decreased by more than 20 percent as value-based reimbursement payments increased, reported the American Medical Group Association (AMGA). But the transition to value-based reimbursement may be slowing down compared...

Do Medicaid Reimbursement, Admissions Produce Hospital Profit?

by Jacqueline LaPointe

Do Medicaid reimbursement rates and federal uncompensated care payments really cover the healthcare costs of treating larger proportions of Medicaid beneficiaries and uninsured individuals? Two new studies in Health Affairs indicate yes,...

Payment Reform Suggestions to Improve Complex Pediatric Care

by Jacqueline LaPointe

Payment reform for medically complex children is needed to support a more family- and patient-centered care delivery model that requires extensive care coordination and non-face-to-face services, a new study in Pediatrics...

Do Hospital Mergers Disincentivize Orgs to Lower Their Costs?

by Jacqueline LaPointe

While hospital mergers and acquisitions increase a healthcare system’s market power to negotiate higher private payer claims reimbursement rates, consolidation may also disincentivize hospitals to lower their healthcare costs, a...

Tips for Negotiating Claims Reimbursement Rates with Payers

by Jacqueline LaPointe

Every dollar counts in the healthcare revenue cycle, especially with declining Medicare reimbursement rates and new value-based care models. But organizations should understand how to successfully negotiate claims reimbursement contracts...

90% Report Clinical Documentation Improvement Boosted Revenue

by Jacqueline LaPointe

Nearly 90 percent of hospitals with 150 or more beds and outsourced clinical documentation functions realized at least $1.5 million in appropriate healthcare revenue and claims reimbursement following clinical documentation improvement...

CMS Issues Final Rule on Home Health Medicare Reimbursement

by Jacqueline LaPointe

CMS recently released a final rule that will reduce Medicare reimbursement to home health providers by $130 million, or 0.7 percent, in 2017. Lower Medicare spending on home health services will stem from updates to payment rates, the Home...

CMS Updates ESRD, Dialysis Medicare Reimbursement Policies

by Jacqueline LaPointe

End-stage renal disease (ESRD) and dialysis providers can expect a 0.73 percent increase in total payments compared to last year under new Medicare reimbursement rates, CMS recently announced. Medicare spending on ESRD payments is...

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...