Ineligible managed care providers currently receive $3 million in Medicaid reimbursements annually, the Government Accountability Office (GAO) said in a report, due to the lack of effective screening...
Over the past month, CMS has announced finalized and proposed rules that would significantly impact payment policies in 2017 for managed care in Medicaid and the Children’s Health Insurance Program...
CMS has released the Skilled Nursing Facility Utilization and Payment Public Use File, a dataset on the care skilled nursing facilities (SNF) provided to Medicare beneficiaries in 2013. The...
Revenue cycle management success is the heart of any healthcare organization. Defined as the clinical and administrative management of claims management, payment, and revenue production, revenue...
Medicaid reimbursement improvements are underway, according to a final rule from the Centers for Medicare & Medicaid Services (CMS). The rule – CMS-2345-FC – provides greater detail about...
Insufficient and inadequate policies and procedures from the Centers for Medicare & Medicaid Services (CMS) require greater levels of federal control to maintain effectiveness, says a report from...
Following the House's recent decision to pass the "doc-fix" bill to permanently repeal the sustainable growth rate (SGR) formula by a vote of 392 to 37, the healthcare industry...
Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice. The crimes reported below result in multiple millions of...
Provider organizations and physicians continue to prepare for the ICD-10’s unknown revenue impact as the October 1, 2015 looms nearer and providers seek to actively protect revenue...
Recently, the Government Accountability Office (GAO) recommended that state Medicaid agencies should mandatorily quantify improper Medicaid payments and inform the effectiveness of their electronic...
A new United States Government Accountability Office (GAO) survey of the Medicaid program integrity systems in ten nationwide areas found there is a substantial puzzle piece missing within the world of...
Legislation is under review for site neutral payment reimbursements where identical reimbursement is offered for two starkly contrasting types of patient care and resources.
Congress will possibly...
The issue of a widespread lack of Medicaid acceptance is ongoing and yet to be resolved. A short-lived increase in Medicaid payments to primary care physicians last year has not generated an increase in...
Study determined Medicaid appointment availability directly correlated to the size of the Medicaid reimbursement increase implemented by the ACA.
The Affordable Care Act (ACA) allows many...
A series of lawsuits show how healthcare providers use the legal system to get improved Medicaid fee reimbursement.
Over the last month, Medicaid fee reimbursement has been a major topic of...
A new study found that a Medicaid fee reimbursement drop of between 40 and 50 percent could happen starting in 2015.
For any hospital or practitioner, knowing the fees that are associated with health...
Between computer and human error, Nebraska received excess payments for Federal Medicaid reimbursement.
The Department of Health and Human Service (HHS) Office of Inspector General (OIG) has released...
While Medicare and Medicaid are similar programs, there offer different challenges when it comes to reimbursement.
Medicaid and Medicare services are often lumped together because they are both...
The New York State Department of Health improperly claimed at least $23 million in Federal Medicaid reimbursement for unallowable supported employment services, according to a recent Office of the...
A California children’s hospital had credit balances that represented overpayments that had not been returned to the Medicaid program, according to a recent audit by the Office of the Inspector...
