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

Claims Reimbursement

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...

25% of Healthcare Payments Tied to Alternative Payment Models

by Jacqueline LaPointe

Only one-quarter of healthcare payments in 2016 will be connected to an alternative payment model that has population-based accountability, reported the Healthcare Payment Learning & Action Network (LAN). The survey of over 70...

Patients Find Medicare Reimbursement to Surgeons Too Low

by Jacqueline LaPointe

Patients may be willing to pay more out-of-pocket expenses for certain medicals services, such as knee surgeries, especially as providers face lower Medicare reimbursement rates, a recent study in Orthopedics contended. The survey of 231...

AHA Offers HHS Solutions to Reduce Medicare Appeals Backlog

by Jacqueline LaPointe

The American Hospital Association (AHA) recently advised the Department of Health and Human Services (HHS) to implement three solutions that would significantly reduce the Medicare appeals backlog at the administrative law judge...

Medicare Reimbursement Covers 88% of Medical Equipment Costs

by Jacqueline LaPointe

Medicare reimbursement rates under the Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program only cover 88 percent of overall healthcare costs associated with providing home medical equipment,...

Hospitals Still Facing Medicare Claims Denial Management Issues

by Jacqueline LaPointe

A recent American Hospital Association (AHA) survey indicated that hospitals are still experiencing challenges with Medicare claims denial management under the Recovery Audit Program. The survey of 676 hospitals revealed that about 60...

OIG: Add Medical Device Data to Claims Reimbursement Forms

by Jacqueline LaPointe

Claims reimbursement forms lacking appropriate fields for medical device information make it more difficult for CMS to reduce Medicare spending associated with recalled or failed devices, the Department of Health and Human Services (HHS)...

Group Calls for Dual-Eligible Claims Reimbursement Changes

by Jacqueline LaPointe

In a recent report, the Bipartisan Policy Center’s Health Project has urged federal officials to improve care delivery for dually eligible Medicaid and Medicare beneficiaries by revising claims reimbursement models to better align...

AHA Urges CMS to Withdraw Uncompensated Care Payment Changes

by Jacqueline LaPointe

The American Hospital Association (AHA) recently penned a letter to CMS Acting Administrator Andy Slavitt urging the federal agency to withdraw its proposed rule to include third-party payments, such as private payer and Medicare...

CMS Releases DMEPOS Medicare Reimbursement Rates, Contracts

by Jacqueline LaPointe

CMS has announced new Medicare reimbursement rates for some medical equipment items and started to send contract offers to winning bidders for Medicare’s Round 1 2017 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies...

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