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


BMC Pays $1.1M to Resolve Medical Billing Fraud Allegations

by Catherine Sampson

Medical billing fraud, waste and abuse in Medicare and Medicaid appears to be an incurable disease. Although funds for these services are supposed to be for vulnerable populations with health needs, they are frequently used for other reasons....

Bundled Payments Program Extended to Improve Value-Based Care

by Jacqueline Belliveau

The Centers for Medicare & Medicaid Services (CMS) recently announced that some healthcare organizations can extend their participation in the Bundled Payments for Care Improvement (BPCI) initiative, a program that aims to increase value-based...

Accountable Care Organization Savings Shift After First Year

by Catherine Sampson

More than 700 accountable care organizations (ACO) currently work toward the goal of improving the quality of healthcare while also reducing capital costs of healthcare thanks to the Affordable Care Act. Meanwhile, researchers attempt to figure...

Healthcare Orgs to Review Healthcare Costs on Open Payments

by Jacqueline Belliveau

According to a recent blog post, CMS is offering healthcare providers a chance to review and dispute healthcare costs related to manufacturers and group purchasing organizations, which will be published on the Open Payments data website on June...

CMS Details How to Resolve ICD-10 Implementation Issues

by Jacqueline Belliveau

In the second update about ICD-10 implementation, CMS has released infographic and statement guidance on how to address issues and questions about IDC-10. The recent statement encourages providers to create a feedback system to review clinical...

CMS Demonstrates How to Track ICD-10 Implementation Progress

by Jacqueline Belliveau

CMS has recently released an infographic urging healthcare providers to assess and analyze their ICD-10 progress by identifying key performance indicators (KPIs) and creating baselines for analysis for each KPI. The recent announcement highlights...

CMS Seeks Final Applications for Next Generation ACO Model

by Jacqueline Belliveau

The Centers for Medicare and Medicaid Services Innovation Center announced the opening of its final round of applications for Next Generation Account Care Organization (ACO) Model, which will begin on January 1, 2017. The final round of Next...

ICD-10 Claim Denial Rate Remains Low among Most Providers

by Vera Gruessner

It seems that the ICD-10 implementation has not had a very negative effect on the ICD-10 claim denial rate, which hasn’t risen much since the October 1 deadline. For example, RelayHealth Financial, a revenue cycle management solutions provider,...

Medicare Home Health Agencies Face Upcoming Payment Changes

by Jacqueline DiChiara

The Medicare home health prospective payment system (HH PPS) can expect payment changes next year, confirms an announcement from the Centers for Medicare & Medicaid Services (CMS). These payment changes aim to ensure greater payment...

CMS Reports 10% Denial Rate in 4.6M Daily Oct. ICD-10 Claims

by Jacqueline DiChiara

The ICD-10 transition has come and gone. Although primary affirmations with large numbers to boot have been reported thus far throughout the month of October, is it perhaps too soon to declare ICD-10 implementation a merely underwhelming endeavor?...

CMS: It’s Quality Over Quantity with Value-Based Purchasing

by Jacqueline DiChiara

The ever familiar “Show me the money!” mentality only rings true in the case of quality over quantity regarding hospital payments, implies the Centers for Medicare & Medicaid Services (CMS). The Hospital...

1 Million First Attempt ICD-10 Claims Yield 99% Success Rate

by Jacqueline DiChiara

Nearly 1,000,000 ICD-10 claims were successfully processed the first time around within the first three weeks of October, confirms a press release from the Advanced Data Systems Corporation (ADS). "ADS was ready for ICD-10...

CMS Issues Proposed 2017-2018 Basic Health Program Notice

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) is releasing newly proposed methodology, to be published today. CMS will be accepting both electronic and non-electronic commentary shortly. Yet another of many payment rules, the 53-page...

CMS Requests Merit-Based Incentive Payment System Discussion

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) will publish a proposed rule tomorrow (CMS-3321-NC2) requesting information about the implementation of the Merit-Based Incentive Payment System (MIPS) and allowing for a comment period...

AHA: Hospital Quality Star Rating System Needs Improvement

by Sara Heath

In an effort to measure hospital and patient care quality, the Centers for Medicare & Medicaid Services (CMS) has introduced the Hospital Quality Star Rating System. However, according to a recent letter from the American Hospital Association...

GAO Advises CMS to Clarify RAC’s Medicare Audit Objectives

by Sara Heath

A recent study by the Government Accountability Office (GAO) has found that the Centers for Medicare & Medicaid Services (CMS) needs to be more hands-on when working with Medicare Part D recovery audit contractor (RAC) programs. CMS began...

CMS Announces Final Rule Implementing Quality Care in SNFs

by Sara Heath

Value-based payment and quality care continue to prove high on the Centers for Medicare & Medicaid Services’ (CMS) agenda. On July 30, the Centers for Medicare & Medicaid Services (CMS) announced their final rules for the fiscal...

CMS Revises ICD-10 FAQ List for Billable Code Clarification

by Sara Heath

Following the July 27 issued ICD-10 frequently asked questions list, the Centers for Medicare & Medicaid Services (CMS) has updated some of the information. These updates primarily clear up confusion regarding family codes and what qualifies...

NAMD Says Medicaid Managed Care Rule Restricts Healthcare Reform

by Sara Heath

In response to the proposed regulations of Medicaid managed care, the National Association of Medicaid Directors (NAMD) submitted a list of comments to the Centers for Medicare & Medicaid Services (CMS), according to a statement made by Matt...

CMS Approves Press Ganey to Administer PQRS CAHPS Survey

by Sara Heath

On July 27, 2015, Press Ganey Holdings, Inc. announced in a press release that it will be one of the vendors approved by the Centers for Medicare & Medicaid Services (CMS) to administer the Physician Quality Reporting System Consumer Assessment...


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