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

Claims Reimbursement

Clinical Documentation Improvement Solutions Up Provider Revenue

by Jacqueline LaPointe

Provider organizations are seeing financial improvements after implementing clinical documentation improvement (CDI) solutions, a recent KLAS survey shows. Revenue improved for about 53 percent of healthcare executives, medical records...

AHA Decries Proposed Expansion of Outpatient Site-Neutral Payments

by Jacqueline LaPointe

CMS should withdraw new proposals to expand site-neutral payments to hospital outpatient clinic visits and services from expanded clinical families delivered at off-campus provider-based departments (PBDs), the American Hospital...

Providers Oppose Collapsing Medicare Reimbursement for E/M Visits

by Jacqueline LaPointe

Providers are calling on CMS to not finalize a proposal to collapse Medicare reimbursement for evaluation and management (E/M) visits into a single, blended payment rate for E/M Levels 2 through 5 visits. In a recently proposed rule for...

RCCH Uses Predictive Analytics to Boost Claim Denials Management

by Jacqueline LaPointe

Predictive analytics are key to implementing an effective and efficient claim denials management strategy that tackles the right denials at the right time, according to the Vice President of Revenue Cycle at Tennessee’s RCCH...

AMA Adds Connected Health CPT Codes, Pushes for Medicare Payment

by Jacqueline LaPointe

The American Medical Association (AMA) updated the Current Procedural Terminology (CPT) code set in 2019 to include new codes for connected health services in an effort to encourage CMS to pay for the services. The 2019 CPT code set...

Paying LTCHs Like Skilled Nursing Would Save $4.6B, Analysis Finds

by Jacqueline LaPointe

Eliminating the concept of long-term care hospitals (LTCHs) would save Medicare $4.6 billion per year without harming patient outcomes, a new National Bureau of Economic Research working paper found. Medicare savings would stem from the...

Artificial Intelligence Ensures Payer, Provider Pay Covers Costs

by Jacqueline LaPointe

Artificial intelligence (AI) in healthcare is influencing the next generation of radiology tools and helping to expand access to care in underserved or developing areas. The technology is supporting clinical advancements, but a...

Providers Praise E/M Documentation Changes, Oppose Payment Plans

by Jacqueline LaPointe

Physicians and other healthcare professionals recently welcomed proposed evaluation and management (E/M) documentation changes from CMS that would reduce administrative burden and streamline Medicare billing. Specifically, the American...

When Claims Reimbursement Doesn’t Cover Healthcare Innovation

by Jacqueline LaPointe

Implementing healthcare innovations that improve care quality is key to boosting patient experience and care quality, but what happens when claims reimbursement doesn’t cover the use of the latest and greatest services? This is the...

HHS to Clear Medicare Appeals Backlog by 2022, Court Docs Show

by Jacqueline LaPointe

HHS is making significant progress with eliminating the growing Medicare appeals backlog, according to recent court documents. The federal department projects Medicare to clear the backlog by the 2022 fiscal year. A 70 percent increase in...

Medicaid Could Save $4.8B Through Electronic Claims Management

by Jacqueline LaPointe

State Medicaid programs are significantly lagging with the adoption of fully electronic claim submissions, claim reimbursements, prior authorizations, and other claims management processes, according to a new Council for Affordable Quality...

Post-Acute Care Providers Worry About Patient-Driven Payment Model

by Jacqueline LaPointe

Leading post-acute care associations are expressing concerns with the recently finalized Patient-Driven Payment Model (PDPM), which will tie skilled nursing facility (SNF) reimbursement to value, rather than therapy volume. CMS issued the...

CMS Finalizes Hospital Price Transparency Rules, 3% Payment Boost

by Jacqueline LaPointe

CMS recently finalized a rule that will establish more comprehensive healthcare price transparency rules for hospitals. In the final rules on the Medicare prospective payment systems for the inpatient (IPPS) and long-term care (LTCH PPS)...

CAQH Stresses the Importance of Prior Authorization Automation

by Jacqueline LaPointe

CAQH’s Committee on Operating Rules for Information Exchange (CORE) is urging a group of industry leaders to encourage prior authorization automation as part of their efforts to improve the entire prior authorization process. The...

CMS Moves Medicare Payments for Skilled Nursing Facilities to Value

by Jacqueline LaPointe

CMS recently finalized a rule that will shift the Medicare payment system for skilled nursing facilities (SNF) away from fee-for-service and toward value starting in 2019. The federal agency will make the move by implementing the...

Hospital Groups Decry Proposed Outpatient Reimbursement Cuts

by Jacqueline LaPointe

Hospitals groups are voicing their concerns with potential site-neutral payments and other outpatient reimbursement reductions proposed in a new rule from CMS. CMS released its proposed CY 2019 Outpatient Prospective Payment System (OPPS)...

Verma: Healthcare Payment Reform to Focus on Docs, Not Hospitals

by Jacqueline LaPointe

Focusing healthcare payment reforms efforts on providers, rather than hospitals, will be key to lowering healthcare costs, CMS Administrator Seema Verma recently told stakeholders. “Over the coming months, we will create new...

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