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

Claims Reimbursement

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...

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)...

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