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

Medical Billing

Insurers Ask Congress to Fix Rates to End Surprise Medical Bills

March 19, 2019 - Organizations representing major health insurers are calling on policymakers to set reimbursement rates for services from out-of-network providers to prevent surprise medical bills. Congress should establish reimbursement rates that “will not increase premiums or impact access for consumers by basing amounts on market rates determined by reasonable, contracted amounts paid by...


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Medical Billing, Patient Access Top Revenue Cycle Risks of 2019

by Jacqueline LaPointe

Patient access and medical billing and collections are among the top healthcare revenue cycle risk areas for hospitals, practices, and other provider organizations in 2019, according to a new report from the public accounting, consulting,...

Healthcare Business Office Experience Impacts Patient Collections

by Jacqueline LaPointe

Consumers are less likely to pay their patient financial responsibility in full if they experience a negative healthcare business office interaction, a new survey shows. The survey of 500 recent healthcare consumers conducted by Connance...

AMA Adds Connected Health CPT Codes, Pushes for Medicare Payment

by Jacqueline LaPointe

The American Medical Association (AMA) updated the Current Procedural Terminology (CPT) code set in 2019 to include new codes for connected health services in an effort to encourage CMS to pay for the services. The 2019 CPT code set...

Paperless Medical Billing Key to Boosting Patient Collections

by Jacqueline LaPointe

In the age of smartphones, tablets, and other technologies that put information literally in the palm of our hands, why do doctors still rely on paper to reach their patients for medical billing purposes? That was the question Max...

Automated Physician Queries Improve Clinical Documentation at WMHS

by Jacqueline LaPointe

Accurate claims reimbursement hinges on complete clinical documentation, and therefore, quick responses to physician queries regarding medical record documentation and coding. This is especially true in Maryland’s unique hospital...

ER Spending Rose 99% Since 2009 Despite No Change in Utilization

by Jacqueline LaPointe

Emergency room (ER) spending per person grew 99 percent between 2009 and 2016 despite ER utilization remaining the same during the period, new data from the Health Care Cost Institute (HCCI) revealed. “Emergency room visits are not...

Healthcare Orgs Still Rely on Paper-Based Medical Billing

by Jacqueline LaPointe

A new survey from Waystar and HIMSS Analytics shows that patients and providers are not seeing eye to eye when it comes to medical billing and collecting patient financial responsibility. The survey of almost 900 financial executives from...

Price Transparency Crucial to Healthcare Consumerism Success

by Jacqueline LaPointe

Providers should brace their practices for the rise and permanence of healthcare consumerism, a new brief from Rice University’s Baker Institute for Public Policy stated. Healthcare consumers are expecting their experiences with...

Patient Financial Responsibility Increased 11% in 2017

by Jacqueline LaPointe

Patient financial responsibility is on the rise, according to findings from a TransUnion Healthcare analysis revealed at HIMSS18. Patients saw their average out-of-pocket costs increase 11 percent in 2017, growing from $1,630 in the fourth...

EHR Adoption Does Not Lower Administrative, Medical Billing Costs

by Jacqueline LaPointe

Electronic health records (EHRs) did not reduce insurance-related and medical billing costs despite the federal government’s claims that EHR adoption would lower administrative expenditures, according to a recent Journal of the...

Addressing Prices, Use at Local Level to Lower Healthcare Costs

by Jacqueline LaPointe

Local patterns of healthcare utilization and pricing resulted in significant healthcare costs variation across five states, a new Network for Regional Healthcare Improvement (NRHI) report showed. NRHI’s second annual report,...

Consolidated Medical Billing Boosts Collections for a TX Group

by Jacqueline LaPointe

Providing a unified medical billing experience was key to improving patient collections by 24 percent in one year at the largest independent multi-specialty physician group in Abilene, Texas. Abilene Diagnostic Clinic boasts 30 physicians...

Healthcare RCM, Medicare Reimbursement Dominate 2017 Stories

by Jacqueline LaPointe

From the Quality Payment Program’s launch to the Affordable Care Act debate, the healthcare finance world saw an abundance of change and uncertainty in 2017. In the face of payment reform and political debates, healthcare leaders...

Medical Billing Codes Do Not Address Full Scope of Primary Care

by Jacqueline LaPointe

Current Procedural Terminology (CPT) codes used for medical billing did not account for all the care provided by primary care physicians in about 60.3 percent of visits, a recent Journal of the American Board of Family Medicine study...

Hospitals, Systems Spend $39B Annually on Regulatory Compliance

by Jacqueline LaPointe

Hospitals, health systems, and post-acute care providers spend almost $39 billion annually on administrative tasks related to regulatory compliance, the American Hospital Association (AHA) reported. “As a result of this...

77% of Leaders Say Their Provider Orgs Use Paper Patient Billing

by Jacqueline LaPointe

While over one-half (52 percent) of patients prefer to receive medical bills electronically, approximately 77 percent of providers still use paper-based patient billing methods, a recent MGMA and Navicure survey revealed. The survey of...

OK Physician Pays $580K to Settle Medicare Fraud Allegations

by Jacqueline LaPointe

A physician from Oklahoma recently agreed to pay $580,000 to settle a Medicare fraud case in which the federal government alleged that he submitted false claims to the federal healthcare program, the  Department of Justice (DoJ)...

36% of Providers Never Address Patient Financial Responsibility

by Jacqueline LaPointe

Healthcare organizations are struggling to collect full patient financial responsibility, especially with the rise of high-deductible health plans. Yet, 36 percent of providers report never discussing a patient’s ability to pay prior...

New Medicare Fraud Audits to Ease Burden on Compliant Providers

by Jacqueline LaPointe

CMS recently updated its Medicare fraud and improper payment audit process to target providers and suppliers who continually demonstrate high medical billing error rates, according to the federal agency’s website. The new Targeted...

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