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

Healthcare Spending

Studies: Hospital Consolidations Cut Competition, Raise Prices

by Jennifer Bresnick

Less competition among providers can lead to higher prices for patients, but access to transparent cost data allows patients to make better choices for themselves. Competition for patients in a local region and the availability of public data...

Are Providers Updating Patients on ACA and Financial Risks?

by Elizabeth Snell

The Affordable Care Act (ACA) not only gives the opportunity for more individuals to find quality health insurance at the right price, it also requires patients to take more financial responsibility in their health. Deductibles and co-pays may...

Health Spending and Job Creation Continues Growth

by Ryan Mcaskill

With more Americans getting insured, health care spending and industry job creation is growing to meet the demand. According to the numbers from the Bureau of Economic Analysis (BEA), the health care sector added 22,600 jobs in September. This...

Pentagon Slashes Autism Healthcare Payments

by Elizabeth Snell

Impending policy changes around TRICARE, a healthcare program for the military and their dependents, have many individuals concerned over how autism therapy coverage will be handled. The Pentagon announced planned healthcare payment adjustments...

CMS Releases First Set of Open Payments Data

by Elizabeth Snell

The Centers for Medicare & Medicaid Services (CMS) released the first round of Open Payments data this week. The move is part of a larger effort to help consumers understand the financial relationship between the health care industry, and...

Why medical practices spend more on business operations

by Elizabeth Snell

As healthcare continues to evolve, it only makes sense that practices might have to hire more staff. However, if a recent survey is any indication, doctors and nurses are not the only ones being brought on to help organizations thrive. Medical...

Will integrated Medicare and Medicaid benefits save money?

by Elizabeth Snell

Individuals who are disabled, under the age of 65 and qualify for both Medicare and Medicaid benefits are known as disabled dual-eligible beneficiaries. In 2009, the Medicare and Medicaid programs spent an estimated $103 billion on those...

CAGW criticizes CMS, Marilyn Tavenner for ACA expenditures

by Elizabeth Snell

Last week, Citizens Against Government Waste (CAGW) stated that the Centers for Medicare & Medicaid Services (CMS) had a “dismal record on financial accountability” and also knocked the organization for dismantling “one...

Youth mental health services to receive $99M in HHS funding

by Elizabeth Snell

The Department of Health and Human Services (HHS) took a huge step forward this week to increase access to mental health services for young people. HHS Secretary Sylvia M. Burwell announced that the agency awarded $99 million in grants to help...

Rate review programs reduce healthcare premiums by $993M

by Elizabeth Snell

The US Department of Health & Human Services’ (HHS) Rate Review Program and Rate Review Grant Program have shown success since their implementations in 2011 and 2010, respectively. Combined, the two programs have reduced total premiums...

Safeguards possibly ineffective on some copayment coupons

by Elizabeth Snell

Pharmaceutical manufacturers’ current safeguards may not prevent all copayment coupons from being used for drugs paid for by Part D, according to a recent Office of Inspector General (OIG) report. The coupons are typically offered to reduce...

Ala. organization overdrew $15M in federal Medicaid funds

by Elizabeth Snell

From 2010 to 2012, the Alabama Medicaid Agency withdrew $14.8 million that exceeded net Medicaid expenditures, according to a recent Office of Inspector General (OIG) report. Specifically, the state agency obtained $18.9 million more in federal...

Medicare ACOs improve care, save $372M in healthcare costs

by Elizabeth Snell

Medicare Accountable Care Organizations (ACOs) improved patient care and generated over $372 million in total program savings, according to the Center for Medicare & Medicaid Services (CMS). The Medicare Shared Savings Program (MSSP) and...

More parents uninsured in states lacking Medicaid expansion

by Elizabeth Snell

States that did not expand Medicaid could be more likely to have uninsured parents, according to a recent Urban Institute survey. The number of uninsured parents living in states that have not expanded Medicaid increased from 50.9 percent in...

Research finds higher Medicare spending in unhealthy states

by Elizabeth Snell

Socioeconomic factors that affect the need for medical care, along with interactions between the Medicare system and other parts of the health system are main reasons why there is variation in Medicare health spending between states, according...

2015 proposed outpatient PPS policy changes, payment rates

by Elizabeth Snell

On Monday, July 14, 2014, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule that would update the payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments...

2015 inpatient psychiatric facility PPS final rule

by Elizabeth Snell

On Wednesday, August 6, 2014, the Centers for Medicare & Medicaid Services announced its final rule for updating the prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs). The...

Summary of FY 2015 Hospice Payment Rate Update

by Elizabeth Snell

On Friday, August 22, 2014, the Centers for Medicare & Medicaid Services (CMS) released the 2015 Hospice Payment Rate final rule, which covers hospice payment rates and the 2015 wage index. The overall economic impact of this final rule is...

Proposed 2015 home health PPS refinements, rate update

by Elizabeth Snell

On Monday, July 7, 2014, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule for the home health prospective payment system (HH PPS) refinements and refine update for the calendar year (CY) 2015. The proposed rule...

2015 skilled nursing facility PPS, consolidated billing

by Elizabeth Snell

On Tuesday, August 5, 2014, the Center for Medicare & Medicaid Services announced its final rule updates for the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2015. ...


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