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

Medicaid Spending

Hospitals Saw No Effect on Margins After Medicaid Expansion

July 5, 2017 - The net impact of Medicaid expansion on non-profit hospital finances was close to zero because uncompensated care cost reductions did not offset Medicaid reimbursement shortfalls, a recent AcademyHealth research revealed. After analyzing IRS filings from 1,700 hospitals between 2009 and 2015, Northeastern University researchers uncovered that Medicaid expansion resulted in about a 25 percent...


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Pediatric Healthcare Costs 35% Less at Community Health Centers

by Jacqueline Belliveau

Pediatric healthcare costs were $1,133 on average among children primarily using community health centers for care versus $1,750 among children seeing other providers, representing a 35 percent difference, a recent Geiger Gibson/RCHN Community...

32 Orgs to Cut Healthcare Costs, Use Under CMS Community Demo

by Jacqueline Belliveau

As part of the Accountable Health Communities Model, CMS recently selected 32 organizations to participate in two of the three program tracks that aim to lower healthcare costs and utilization by fostering clinical and community service provider...

CMS Reveals Medicare-Medicaid Accountable Care Organization

by Jacqueline Belliveau

CMS recently unveiled a Medicare-Medicaid accountable care organization (ACO) model that will allow participating providers in the Medicare Shared Savings Program to take on accountability for Medicaid costs and quality of care for dual-eligible...

CMS Proposes to Limit Supplemental Medicaid Reimbursement

by Jacqueline Belliveau

CMS recently proposed a rule that would limit a state’s ability to create or increase a Medicaid reimbursement structure for hospitals, physicians, and nursing homes that pays providers for services that are not related to care delivery...

States Could Build Upon the Affordable Care Act to Cut Costs

by Vera Gruessner

The Affordable Care Act has had two main goals for the healthcare system: Increase health insurance coverage for Americans and lower healthcare spending around the country. At this point in time, the Affordable Care Act has brought health coverage...

GAO to CMS: State Medicaid Payment Flaws Hurt Transparency

by Jacqueline DiChiara

The reliability regarding tens of billions of dollars in states’ supplemental payments is being called into question this month by the United States Government Accountability Office (GAO). Because complete reliable data is deficient, transparency...

CMS Final Rule Improves Medicaid Beneficiaries’ Care Access

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) has released a final rule – effective on January 4, 2016 – that aims to advance the way covered services are measured and strengthen Medicaid beneficiary protection and care access....

Medicaid Expansion Bill, HELP Act, Signed by MT Governor

by Jacqueline DiChiara

Medicaid coverage is multiplying for low-income beneficiaries via the Montana HELP Act. Bipartisan legislation (SB405) was recently signed by Montana Governor Steve Bullock, expanding Medicaid coverage to residents between the ages...

Tennessee Shoots Down Medicaid Expansion

by Ryan Mcaskill

In a 7-4 vote, the Tennessee Senate rejected a plan to expand Medicaid coverage in the state. Last month, it was announced that the state of Indiana became the 28th state (including Washington D.C.) to adopt the Medicaid program under the Affordable...

How Too Much Choice is Increasing Nursing Home Costs

by Ryan Mcaskill

A nursing facility building boom in Indiana will cost the state $24 million in additional Medicaid program payments. It is hard to imagine that building more nursing homes in a specific state could have any drawbacks. Unfortunately, because of...

New York OMIG Saves $2B, Recovers $879M in Medicaid Spending

by Ryan Mcaskill

Last week, New York State’s Office of the Medicaid Inspector General (OMIG) released its 2013 annual report that focuses on spending and fraud prevention. It includes the final totals for Medicaid recoveries and cost savings during the...

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