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

Healthcare Spending

Does Medicare Part D Prescriber Data Improve Transparency?

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) has announced the availability of updated privacy-protected data on Medicare Part D prescription drugs. The presented data explains which prescription drugs were prescribed to Medicare...

Streamlined Core Measures Advance Cost-Effective Healthcare

by Jacqueline DiChiara

Improved health at lower cost means paying special attention to magnified metrics. This task is no simple feat. Although there are currently thousands of possible core measures providing healthcare professionals, payers, policy makers, and beneficiaries...

MACRA Fee Adjustments May Generate Financial Consequence

by Jacqueline DiChiara

Physicians and healthcare providers may endure an even greater financial consequence under the $200 billion Medicare reform package signed by President Obama last week, H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA) than before...

ICD-10 Compliance: From Provider Uncertainty to Certainty

by Jacqueline DiChiara

Tick tock goes the ICD-10 clock. As the ICD-10 implementation October 1, 2015 date looms closer, hesitation within the healthcare industry blossoms as providers struggle to stay in the game. Can general uncertainty around the implementation...

Physician-Led ACOs Need Opportunities to Thrive

by Jacqueline DiChiara

Many of the HIMSS15 educational sessions this week in Chicago offered valuable insight into the financial future of the healthcare industry. Farzad Mostashari, MD, ScM, Aledade Inc. Founder and CEO and former National Coordinator...

April 17: 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 of dollars...

Mechanized Claims Processing the Future of Medicaid?

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) present a proposed rule to extend enhanced federal financial participation for Medicaid eligibility and enrollment systems beyond the...

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 Humana,...

AMA CEO: Flawed SGR No Longer Threatens Payment Delivery

by Jacqueline DiChiara

James L. Madara, MD, Chief Executive Officer and Executive Vice President of the American Medical Association (AMA), provided insight via a morning media conference today on the organization’s perspective regarding the Senate’s overwhelmingly...

$100B Aftermath of Medicare Access, CHIP Reauthorization Act

by Jacqueline DiChiara

The ongoing push for value-based reimbursement endures with the finalization of new legislative decisions regarding the permanent SGR repeal's ripple effect on the healthcare industry at large. The Medicare Access and CHIP...

Costly Impact of CMS’ Mental Health Parity Rule on Medicaid

by Jacqueline DiChiara

Expensive treatment for a mental health or substance use disorder often means imposed limitations in insurance coverage. Medicaid programs may soon carry the burden of alleviating such costs. The Centers for Medicare & Medicaid Services (CMS)...

Does ACA Boost Physicians’ Medicaid Participation?

by Jacqueline DiChiara

Medicaid beneficiaries are keeping the doctor away. Newly released data may offer a fresh industry-wide perspective about how often physicians accept Medicaid regarding delayed implementation stemming from the Affordable Care Act’s (ACA’s)...

Medicaid Providers Struggling to Raise Reimbursement Rates

by Jacqueline DiChiara

Medicaid providers seeking to raise their reimbursement rates by suing the government are essentially out of luck, according to documentation within a recent Supreme Court ruling. “The notion that respondents have a right to sue,”...

Has the Affordable Care Act Led to a Slowdown in Premiums?

by Jacqueline DiChiara

Slow and steady appears to be the financial mantra echoing forth within the healthcare industry. There has been a distinct deceleration in premium growth within the past three years following the implementation of Affordable Care Act...

CMS Announces Possible Delay as Medicare Doc Payment Begins

by Jacqueline DiChiara

The Bipartisan Permanent Sustainable Growth Rate (SGR) Fix and Children’s Health Insurance Program (CHIP) Reauthorization Package replaces the flawed Medicare formula as a “doc-fix.” This legislation aims to transition...

Why Is Medicaid Expansion a Win for Healthcare Providers?

by Jacqueline DiChiara

As anyone standing before a plate of freshly baked desserts or fearfully opening a credit card bill post online shopping binge can attest, the art of equilibrium is essential. This idea of balance is also needed within the financial realm of...

What is the Future of Revenue Cycle Management?

by Jacqueline DiChiara

A crystal ball showing the future of revenue cycle management depicts a spotlight brightly shining down upon an individual wearing three different hats – those of the healthcare consumer, patient, and payer. This increased focus will continue...

HHS Launches Health Care Payment Learning and Action Network

by Jacqueline DiChiara

The Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell met with President Obama to launch the Health Care Payment Learning and Action Network. An estimated 2800 payers, providers, employers, patients, states, consumer groups,...

OIG Testimonies Examine 340B Savings and Medicare Fraud

by Jacqueline DiChiara

The Office of the Inspector General (OIG) recently posted written testimonial on 340B savings and Medicare fraud, as submitted to the House of Representatives from Ann Maxwell, Assistant Inspector General of the OIG Office of Evaluation and Inspections,...

Electronic Transactions Could Save Healthcare Billions  

by Jacqueline DiChiara

As the healthcare industry continuously eliminates paper-based administrative processes and pushes for mainstream electronic transactions, the possible result is essentially tens of billions in savings for the healthcare industry. If six routine...

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