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

Claims Reimbursement

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...

Using Data Analytics to Decrease Claims Denials, Boost Revenue

by Jeff Wood

Claims denials typically represent one of the largest revenue cycle bottlenecks in most healthcare organizations.  However, slowing down to determine why claims are being denied hasn’t traditionally been an option. The light at...

WEDI Guide Suggests New Electronic Fund Transfer, ERA Standards

by Jacqueline LaPointe

The Workgroup for Electronic Data Interchange (WEDI) recently released a guide that advised all healthcare stakeholders to implement Automated Clearing House (ACH) Electronic Funds Transfers (EFT) and Electronic Remittance Advice (ERA)...

AMGA: Tie Medicare Reimbursement to Care Coordination Metrics

by Jacqueline LaPointe

According to two comment letters to CMS, the American Medical Group Association (AMGA) has urged the federal agency to better align Medicare reimbursements and value-based incentive payments to promote enhanced care coordination. The...

Adjusted DMEPOS Payments to Reduce Medicare Spending by $19M

by Jacqueline LaPointe

Medicare spending would decrease by approximately $19 million a year once CMS fully implements new claims reimbursement rates for accessories associated with some durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS),...

MedPac Suggests More Claims Reimbursement Cuts for Home Health

by Jacqueline LaPointe

The Medicare Payment Advisory Commission (MedPac) is advising CMS to deepen proposed Medicare reimbursement cuts to home health advisors to better align with actual costs and compensate for systematic overpayments. The call for more...

AHA Critiques Medicare Reimbursement Changes for Home Health

by Jacqueline LaPointe

The American Hospital Association (AHA) is urging CMS to delay outlier provisions and streamline certain medical billing procedures proposed in a recent document aimed at home health facilities. In June, CMS released a proposed rule that...

Group Calls for Off-Label Drug Claims Reimbursement Guide

by Jacqueline LaPointe

The federal government should develop a single resource that clarifies what off-label drug uses would qualify for federally-funded claims reimbursement, researchers stated in a recent study in the Journal of the American Medical...

AMGA Urges CMS to Release Claims Reimbursement Plan for CPC+

by Jacqueline LaPointe

The American Medical Group Association (AMGA) has called on CMS to release the claims reimbursement formula for the Comprehensive Primary Care + (CPC+) model, according to a letter sent to the federal agency earlier this week. The...

Patients Led to Private Plans to Boost Claims Reimbursement?

by Jacqueline LaPointe

The federal agency is investigating whether some healthcare providers or provider-affiliated organizations are encouraging individuals eligible for Medicare and/or Medicaid to enroll in individual market plans under the Affordable Care Act...

CMS Clarifies Medicaid Uncompensated Care Reimbursement Plan

by Jacqueline LaPointe

CMS plans to use third party and Medicare claims reimbursements to calculate hospital-specific uncompensated care costs and distribute Medicaid Disproportionate Share Hospital payments, according to a proposed rule from the federal...

CMS Final Rule Updates Inpatient Claims Reimbursement System

by Jacqueline LaPointe

Providers can expect an array of changes to Medicare claims reimbursement and value-based care programs starting in October, according to a final rule issued by CMS earlier this week. The 2,434-page final rule primarily updated the...

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