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

Claims Reimbursement

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...

CMS Updates Part A Claims Reimbursement, Auditing Policies

by Jacqueline LaPointe

To give providers enough time to properly engage claims reimbursement and denials management procedures, CMS has announced that medical reviews on Medicare Part A claims under the two-midnight rule will be limited to a six-month look-back...

Providers in Iowa Face Medicaid Claims Reimbursement Delays

by Jacqueline LaPointe

After privatizing the Medicaid program in April, some healthcare providers in Iowa have experienced serious delays in Medicaid claims reimbursement that have caused some organizations to consider shutting their business doors. According...

Industry Group Advises HHS to Expand Bundled Payment Models

by Jacqueline LaPointe

The Center for American Progress (CAP), a Washington think tank, has called on the federal government to expand bundled payment models in order to further reduce healthcare costs and advance value-based care. The letter to Department...

CMS: Proposed Changes to Dialysis, ESRD Claims Reimbursement

by Jacqueline LaPointe

The Centers for Medicare and Medicaid Services (CMS) has recently announced proposed changes to claims reimbursement models for end-stage renal disease (ESRD) and dialysis as well as revisions to the competitive bidding program for durable...

CMS Releases Medicare Reimbursement Schedule for DMEPOS Items

by Jacqueline LaPointe

The Centers for Medicare & Medicaid Services (CMS) has released an updated fee schedule for Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), which adjusts Medicare reimbursements to suppliers based on...

Uncompensated Care Drops by $6B after Medicaid Expansion

by Jacqueline LaPointe

Numerous individuals seek necessary medical services at hospitals regardless the ability to pay, but uncompensated care costs from charity cares and patient debt can strain hospital revenue cycles. However, as states develop Medicaid...

CMS Updates Medicare Reimbursement Schedule for Lab Tests

by Jacqueline LaPointe

A new methodology for calculating Medicare reimbursement rates for laboratory tests is on the horizon, according to a fact sheet from the Centers of Medicare and Medicaid Services (CMS). According to a final rule issued this week,...

Ambulatory Surgery Centers Help Reduce Healthcare Costs

by Jacqueline LaPointe

With a push for more healthcare transparency, more beneficiaries are now equipped to reduce healthcare costs by selecting the cheapest option for medical services. However, some providers may not be as lucky since site of care can create...

CMS Announces Pre-Claims Reimbursement Review for Home Health

by Jacqueline LaPointe

In efforts to combat Medicare fraud and provide more timely care to beneficiaries, the Centers for Medicare and Medicaid Services (CMS) has issued a rule that requires some home health agencies to undergo a pre-claim review to qualify for...

GAO: Backlog Persists for Claims Reimbursement Appeal Process

by Jacqueline LaPointe

Discovering that a claim has been denied is hard enough, but the appeals process that manages claims reimbursement disputes may be even harder to handle for most healthcare providers. According to a recent report from the Government...

How to Manage ICD-10 Implementation Updates, Maximize Revenue

by Jacqueline LaPointe

Just as most healthcare stakeholders reported that ICD-10 implementation ran smoother than expected, CMS will be releasing 5,500 new codes beginning in October. While it may sound like a large update to the system, the new codes could help...

8 Tips for Avoiding Denials, Improving Claims Reimbursement

by Michelle Tohill of Bonafide

If your practice is like most, your billing staff sees the words “CLAIM DENIED” fairly often, which not only leads to frustration and increased work but also reduced revenue for the practice over time. A recent study by the...

Why Claims Accuracy Testing, QA Isn’t Working for Healthcare

by Mark Benedict

Let’s face it. Testing isn’t working.  That’s the hard truth about the healthcare industry and its track record on claims accuracy testing and quality assurance. The harder truth is that this problem is expensive...

$628K Awarded to Boost US Healthcare Spending Research

by Jacqueline LaPointe

The Peterson Center on Healthcare has awarded a $628,000 grant to the University of Washington’s Institute for Health Metrics and Evaluation (IHME) to analyze US healthcare spending and predict future spending trends, a recent...

AHA Endorses Quality Reporting Software for Value-Based Care

by Jacqueline LaPointe

The American Hospital Association (AHA) recently announced that it has endorsed ENCOR Quality Reporting and Management Solution from Medisolv Inc. for providing services and products that help member healthcare providers improve...

VA Creates Call Center to Reduce Claims Reimbursement Delays

by Jacqueline LaPointe

The Department of Veterans Affairs (VA) has established a community care call center to assist veterans and healthcare providers who are experiencing issues with debt collection because of incorrect or delayed claims reimbursement payments...

CMS Releases Post-ICD-10 Claims Denial Reimbursement Metrics

by Jacqueline DiChiara

Post-ICD-10 implementation claims denial is a top 2016 focus for healthcare organizations. According to last month’s ICD-10 survey from Porter Research and Navicure, healthcare organizations cite value-based care as a leading focus....

What Are the Front-End Steps of Revenue Cycle Management?

by Jacqueline DiChiara

Revenue cycle management is the progression of events between when a patient makes a doctor’s appointment and when a patient’s money is received and reimbursed for following care delivery. When a service has been...

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