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

Claims Reimbursement

Healthcare Claims Management Market to Reach $13.9B by 2023

by Jacqueline LaPointe

The global healthcare claims management market is slated to reach $13.93 billion by 2023, up from a valuation of $10.16 billion in 2017, MarketsandMarkets recently reported. The significant projected growth in the healthcare claims...

AMIA Calls for Activity Reporting in Promoting Interoperability

by Jacqueline LaPointe

CMS should replace process measure reporting in the new Promoting Interoperability program with activity-based reporting as in the Improvement Activities performance category of Merit-Based Incentive Reporting System (MIPS), the American...

Federal Policies to Decrease Hospital Payments by $218B by 2028

by Jacqueline LaPointe

Several federal policies since 2010 will reduce hospital payments by a total of $218.2 billion by 2028, a new report from the health economics consulting firm Dobson | DaVanzo and Associates revealed. The report commissioned by the...

Electronic Claims Management Adoption Could Save Providers $9.5B

by Jacqueline LaPointe

Transitioning from manual to fully electronic claims management would save the healthcare industry $11.1 billion annually, with providers seeing the greatest share of the savings, the fifth annual CAQH Index found. Providers would save...

Oncologist Org Fights Medicare Reimbursement Cut to Cancer Drugs

by Jacqueline LaPointe

A group representing over 5,000 independent, community-based oncologists is suing HHS over the implementation of a two percent sequester cut to Medicare reimbursement for Part B cancer drugs. The Community Oncology Alliance (COA) is...

CMS Proposes New Pre-Claim Review for Home Health Agencies

by Jacqueline LaPointe

CMS is floating the idea of implementing another pre-claim review of Medicare claims submitted by home health agencies in at least five states, according to a recent notice of proposed information collection. The federal agency proposed...

Expanded Resolution Process Opens to Lower Medicare Appeals Backlog

by Jacqueline LaPointe

HHS recently announced an expanded alternative dispute resolution process that aims to reduce the growing Medicare appeals backlog. The expanded Settlement Conference Facilitation (SCF) process promises to streamline Medicare dispute...

Half of PCPs Aware of Medicare Reimbursement for Chronic Care Mgmt

by Jacqueline LaPointe

CMS recognized that chronic disease management is key to lowering healthcare costs and improving patient outcomes by creating a Medicare reimbursement code for chronic care management. However, provider knowledge of the payment is...

Hospitals Wait 16 More Days for Late Payments from Claim Denials

by Jacqueline LaPointe

Delayed payments stemming from claim denials are significantly impacting hospital revenue cycles, taking an average 16.4 more days to pay compared to claims that have not been denied, a new analysis from Crowe Horwath revealed. The...

CMS to Up Medicare Payments, Reduce Burdens for Inpatient Rehabs

by Jacqueline LaPointe

CMS is seeking to reduce the administrative burden for inpatient rehabilitation facilities on top of a proposed $75 million Medicare payments increase in the 2019 fiscal year. The federal agency released several proposed rules for...

CMS Proposes Patient-Driven Pay for Skilled Nursing Facilities

by Jacqueline LaPointe

CMS recently proposed updates to several post-acute care prospective payment systems, with skilled nursing facilities seeing a potentially new Medicare reimbursement arrangement, called the Patient Driven Payment Model. The Patient Driven...

Rural Hospitals Get Low-Volume, Medicare-Dependent Funds Extended

by Jacqueline LaPointe

While the recent 2019 Medicare Inpatient Prospective Payment System (IPPS) rule brought major changes to healthcare price transparency and meaningful use, the rule also extended two key payment programs for small and rural hospitals. Those...

AMA, ASAM Create Alternative Payment Model for Opioid Use Disorder

by Jacqueline LaPointe

The American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) recently unveiled an alternative payment model that aims to improve care and reduce costs associated with opioid use disorder. The new...

CMS Appeals Ruling on Changing Medicaid DSH Payment Rules in MO

by Jacqueline LaPointe

CMS is appealing a recent federal court decision that barred the agency from enforcing a 2017 final rule and two sub-regulatory articles from 2010 in Missouri. The federal agency stated that rule and articles clarified the formula for...

MedPAC Suggests Cutting Medicare Reimbursement for Stand-Alone EDs

by Jacqueline LaPointe

The Medicare Payment Advisory Commission (MedPAC) recently voted to reduce Medicare reimbursement by 30 percent for off-campus stand-alone emergency departments (ED) in urban areas. The recommendation will be included in the...

Judge Asks AHA to Develop Medicare Appeals Backlog Solutions

by Jacqueline LaPointe

A federal judge is calling on the American Hospital Association (AHA) to recommend strategies to reduce the growing Medicare appeals backlog, a recent court order stated. According to the AHA’s website, US District Judge James...

Medical Billing Complexity Highest for Medicaid Fee-for-Service

by Jacqueline LaPointe

Medical billing for Medicaid fee-for-service claims proved to be the most complex across all insurers. The public payer had a claims denial rate 17.8 percentage points greater than the rate for Medicare fee-for-service claims, a new Health...

Site-Neutral Medicare Reimbursement Too Low for LTCHs, AHA Argues

by Jacqueline LaPointe

Site-neutral Medicare reimbursement for long-term care hospitals (LTCHs) will cover less than half the actual costs of care for qualifying cases, the American Hospital Association (AHA) recently told CMS. The Bipartisan Budget Act of 2013...

Bringing Profee, Facility Together to Maximize Coding Productivity

by Jacqueline LaPointe

Professional and facility coding describe two very different aspects of a healthcare. But breaking down the wall between the departments has the potential to boost coding productivity and improve clean claim rates. While professional...

92% of Docs Say Prior Authorizations Negatively Impact Outcomes

by Jacqueline LaPointe

Physicians are reporting that prior authorizations are negatively affecting patient care, a new American Medical Association (AMA) survey of 1,000 physicians showed. Ninety-two percent of primary care and specialty physicians who provide...

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