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

Healthcare Reform

Medicare Public Option Would Cut Hospital Reimbursement by $774B

March 15, 2019 - A new report shows implementing a Medicare public option would decrease hospital reimbursement by $774 billion over a ten-year period, representing a ten percent reduction in payments. The report, prepared by KNG Health Consulting on behalf of the American Hospital Association (AHA) and Federation of American Hospitals (FAH), also revealed that hospitals in non-metropolitan areas would...


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White House Proposes $845B in Medicare Spending Cuts

by Jacqueline LaPointe

President Trump’s budget proposal for the 2020 fiscal year is requesting a tightening of the purse strings for HHS, including $845 billion in Medicare spending cuts over the next decade. The budget proposal released March 11 by the...

Healthcare Price Transparency in NH Reduced Out-of-Pocket Costs

by Jacqueline LaPointe

Healthcare price transparency shifts care to lower-cost providers and saves consumers and payers money, according to a recent study out of the University of Michigan. Costs fell by five percent for patients and four percent for insurers...

Prices Still Responsible for High US Healthcare Spending

by Jacqueline LaPointe

Prices are still the primary reason healthcare spending in the US more than doubled from 2000 to 2016, revealed a new follow-up study to the landmark 2003 article titled “It’s the Prices, Stupid.” The article’s...

CMS Seeks Info on a Direct Provider Contracting Model for Medicare

by Jacqueline LaPointe

CMS is seeking comments on a potential alternative payment model that would allow primary care providers to directly bill Medicare beneficiaries through a direct provider contracting model. Currently, providers must opt out of Medicare...

Value-Based Purchasing Top Health Reform Priority for Governors

by Jacqueline LaPointe

In a recent healthcare reform proposal, a bipartisan group of governors emphasized that value-based purchasing implementation will be the key to reducing healthcare costs while improving outcomes. “Coverage is important, and...

How Healthcare Reform, Value-Based Care Define High-Performance

by Jacqueline LaPointe

Whether through the Triple Aim or Institute of Medicine’s six aims, healthcare reform efforts and value-based care models intend to transform health systems and hospitals into high-performing entities. But what exactly does it mean...

Orgs Offer Regulatory Relief to Boost Value-Based Purchasing

by Jacqueline LaPointe

In response to the recent CMS call for stakeholder feedback on how to provide regulatory relief, industry groups detailed ways to reduce red tape associated with value-based purchasing implementation. Hospitals and individual providers...

Execs To Continue Value-Based Purchasing Despite Uncertainty

by Jacqueline LaPointe

Despite a possible Affordable Care Act repeal, healthcare executives still plan to stay the course with value-based purchasing implementation and healthcare cost reduction initiatives, a recent BDC Advisors survey reported. Although the...

MedPAC Targets Post-Acute Care for Healthcare Payment Reform

by Jacqueline LaPointe

In its March 2017 report to Congress, the Medicare Payment Advisory Commission (MedPAC) pinpointed post-acute care for healthcare payment reform after Congressional and CMS inaction resulted in as much as $11 billion in lost savings since...

Senate Confirms Seema Verma as Next CMS Administrator

by Jacqueline LaPointe

In a 55 to 43 vote yesterday, the Senate confirmed Seema Verma as the next CMS Administrator, according to a New York Times article. Verma, the founder, president, and CEO of a health policy consulting firm, will be charged with...

AHA, FAH Oppose Proposed Physician Self-Referral Law Changes

by Jacqueline LaPointe

The American Hospital Association (AHA) and the Federation of American Hospitals (FAH) recently urged lawmakers to oppose a proposed bill that would extend physician self-referral allowances to physician-owned hospitals. In late February,...

Executive Order Calls for ACA Financial, Marketplace Flexibility

by Jacqueline LaPointe

Just hours after taking office, President Trump signed a broad executive order that intends to minimize the “economic burden of the Patient Protection and Affordable Care Act” before an official repeal of the law. Under the...

Do Nurse Practitioners Increase Healthcare Spending Rates?

by Catherine Sampson

While the use of independent nurse practitioners (NPs) is often seen as an important way to drive down healthcare spending rates, a new report from researchers at the University of California San Francisco indicates that the...

For Truly Value-Based Care, Use Outcomes Instead of Processes

by Catherine Sampson

Value-based care is the goal of many of the nation’s healthcare reform efforts, yet basing regulatory changes and provider-facing metrics on checking off processes instead of achieving outcomes could be the wrong approach, states a...

House Budget Proposes ACA Repeal, Reduced Medicare Spending

by Jacqueline LaPointe

The House of Representatives proposed budget plan for 2017 from the House Budget Committee aims to repeal the Affordable Care Act (ACA), reduce Medicare spending, and give states more control with health programs. “With respect to...

The Affordable Care Act’s Effect on Hospital Charity Care

by Jacqueline DiChiara

Hospitals provide charity care according to patients’ income levels. But policies and patient criteria often vary depending on the particular hospital. Supporting hospital charity care while maintaining tight margins is a challenge,...

AHA: Stark Law Exception Advances Alternative Payment Models

by Jacqueline DiChiara

Congress should focus on improving federal fraud and abuse laws, said the American Hospital Association (AHA) to the Senate Finance and House Ways and Means Committee last week. The AHA advocated for an exception to be created under the...

Why Flawed Alternative Payment Model Design Holds MACRA Back

by Jacqueline DiChiara

Alternative Payment Models (APMs) do not adequately address payment system problems, according to a new report from the Center for Healthcare Quality and Payment Reform (CHQPR). Healthcare payment reform is apparently progressing at a...

High Patient Experience Ratings Up Revenue Cycle Management

by Jacqueline DiChiara

Positive patient experience ratings generate a healthy and happy revenue cycle management, according to Press Ganey’s new white paper. But healthcare payment reform challenges may be keeping providers from seeing more...

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