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

Claims Reimbursement

Revenue Cycle Management Success is About the Fundamentals

by Jacqueline DiChiara

Revenue cycle management success is the heart of any healthcare organization. Defined as the clinical and administrative management of claims management, payment, and revenue production, revenue cycle management is in essence one...

4 Revenue Cycle Management, Claims Reimbursement Strategies

by Jacqueline DiChiara

Organized claims processing and accurate payment help maintain strong revenue cycle management.  But keeping track of claims reimbursement processes and operations involves a great deal of seemingly convoluted steps.  The life...

How Provider Interaction Reduces Claims Reimbursement Waste

by Jacqueline DiChiara

Reducing claims reimbursement waste demands a closer look at the inner workings of the medical billing environment and how to improve provider interactions. A lack of communication may be a leading cause of claims reimbursement waste and...

Value-Based Care Models Still Pose Opportunities, Challenges

by Jacqueline DiChiara

The value-based care model is allegedly winning the claims reimbursement race, leaving its fee-for-service competitor in the dust. How valid is the widespread claim that value-based reimbursement models are tied to higher care quality...

Do Accountable Care Organizations Save Claims Reimbursement?

by Jacqueline DiChiara

Accountable care organizations (ACOs) are reportedly being penalized for high revenue cycle management performance. Healthcare providers looking to manage their claims reimbursement strategies remain focused on value-based care initiatives...

5 Claims Reimbursement Questions and Answers

by Jacqueline DiChiara

Money talks and the healthcare industry is listening. Claims reimbursement was one of many weighty revenue cycle management topics the healthcare industry kept an ear out for this year. From the art of claims scrubbing to figuring out how...

5 Claims Denials Management Conversations From 2015

by Jacqueline DiChiara

This year, the healthcare industry lived in denial. Claims denial, that is. Claims denials management dialogues were extensive and recurring among healthcare providers across the industry this year.  Here are 5 claims...

86% of Physicians Say ICD-10 Diverts Focus from Patient Care

by Jacqueline DiChiara

With ICD-10 – the tenth edition of the International Classification of Diseases – implementation now a tangible reality as the healthcare industry enters mid-October, questions about ICD-10’s detrimental patient impact...

How to Rescue Revenue Cycle with Medicare Appeals Pending

by Jacqueline DiChiara

The rehabilitation needs of Medicare beneficiaries within the state of California may be in jeopardy. Payment for hundreds of thousands of claims for services is being denied. Most of these denials are reportedly invalid, confirms past...

HHS Urged to Resolve Pending Medicare Appeals in Filed Suit

by Jacqueline DiChiara

Casa Colina Hospital and Centers for Healthcare recently filed suit to require timely Medicare patient care appeals mandated under federal law.  The Medicare program is denying payment for hundreds of thousands of claims for...

May 15: Week That Was in Healthcare Fraud and Malpractice

by Jacqueline DiChiara

Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice and the Office of Inspector General. The crimes reported below result in multiple millions...

May 8: Week That Was in Healthcare Fraud and Malpractice

by Jacqueline DiChiara

Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice (DOJ) and the Office of Inspector General (OIG). The crimes reported below result in multiple...

Value-Based Reimbursement: Humana CEO’s Payer Perspective

by Jacqueline DiChiara

In a Tuesday morning keynote speech at the Healthcare Information and Management Systems Society’s (HIMSS’) annual HIMSS15 conference and exhibition conducted this week in Chicago, Bruce D. Broussard, CEO and President of...

Medicare Physician Fee Schedule Updated with SGR Methodology

by Jacqueline DiChiara

Medicare’s Physician Fee Schedule (MPFS) is associated with an inflation algorithm that has been criticized for not paying physicians enough to be able to effectively administer quality care to Medicare beneficiaries. MPFS...

New WEDI Focus on Bundled Payments, Value-Based Initiatives

by Jacqueline DiChiara

The Workgroup for Electronic Data Interchange (WEDI) recently announced its Payment Models Workgroup is forming a new project team committee – the Bundled Payments Taskforce – to more closely examine bundled payments and...

CMS Delays Two-Midnight Rule, Medicare Claims Now Pending

by Jacqueline DiChiara

The ongoing financial debate between hospitals and physicians about what differentiates an inpatient from an outpatient in terms of administered payment after the stroke of midnight (or two) continues to evolve. The Centers for...

Does the Sustainable Growth Rate Mean Smarter Reimbursement?

by Jacqueline DiChiara

Last week, the House of Representatives passed legislation that permanently repealed the Sustainable Growth Rate (SGR) formula and established an original reimbursement plan with fundamentally implemented value-based care incentives. The...

Quantify Denial Rates for Smooth Revenue Cycle Management

by Jacqueline DiChiara

A hospital or medical practice’s ability to swiftly and economically process claims and quantify denial rates is critical to ensure smooth revenue cycle management and medical reimbursement. The ability to accurately predict...

AHA Sees Reimbursement as an ICD-10 Implementation Challenge

by Jacqueline DiChiara

Reimbursement is a key aspect that will play a big role by ICD-10 implementation as the Oct. 1, 2015 deadline approaches and speculation abounds as to the damaging financial effects an unsuccessful ICD-10 transition could have on...

What Steps Comprise the Life Cycle of a Medical Claim?

by Jacqueline DiChiara

Although reimbursement is a vital aspect within a claim’s life cycle, it is certainly not the only vital piece. It is important to recognize and distinguish each stage from the other within the total life cycle of a medical claim to...

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