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

Medicare and Medicaid Services

‘Unjustified’ Premium Increases Obstruct ACA’s Transparency

by Jacqueline DiChiara

Covered California – which encompasses almost 13 percent of all Marketplace enrollees paying for nationwide coverage – announced yesterday a “modest” anticipated 4 percent statewide weighted average increase for 2016 healthcare...

CMS Approves Press Ganey to Administer PQRS CAHPS Survey

by Sara Heath

On July 27, 2015, Press Ganey Holdings, Inc. announced in a press release that it will be one of the vendors approved by the Centers for Medicare & Medicaid Services (CMS) to administer the Physician Quality Reporting System Consumer Assessment...

As Medicare Turns 50, Does It Still Make Financial Sense?

by Sara Heath

As Medicare’s 50th birthday approaches, critics begin to question whether the program should be rescued and updated for today’s health economy, or if it should be phased out and eventually dissolved, according to a news...

Is CMS’s Hospital Quality Star Rating System Non-Compliant?

by Jacqueline DiChiara

The Hospital Quality Star Rating System from The Centers for Medicare and Medicaid Service (CMS) is facing scrutiny. Some industry-wide trepidation exists about whether or not CMS’s Hospital Quality Star Ratings System will result in actionable,...

July 24: 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...

CMS Trustees Report Historic Low in Medicare Cost Growth

by Sara Heath

Growth in Medicare costs remains low, according to the Trustees report released on July 21 by the Centers for Medicare & Medicaid Services (CMS). The Trustees report indicates that the Medicare trust fund will remain solvent until 2030, which...

New Growth in Home and Community-Based Services Spending

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) has released its “milestone” 2013 Medicaid Expenditures for Long-Term Services and Supports Report. According to the Center for Medicaid and CHIP Services (CMCS), 2013 was the...

AK Gov. Proposes Sept. Medicaid Expansion Reform Under ACA

by Jacqueline DiChiara

Medicaid expansion may be the key to cutting state spending. The governor of Alaska, Bill Walker, recently notified a state committee that he plans to accept both federal and Mental Health Trust Fund Authority money to expand Medicaid to underprivileged...

Medicare Care Choices Model Awards Drive Choice, Quality

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) is focused on helping Medicare beneficiaries, their families, and loved ones acquire the right type of healthcare. This week, CMS announced the 141 urban and rural hospices selected...

CMS Conducts Hospital Quality Star Rating System Run-Through

by Jacqueline DiChiara

Buckle up. The Centers for Medicare & Medicaid Services (CMS) is giving its Hospital Quality Star Rating System a vigorous test drive to review its production process, increase system understanding, and provide an opportunity for hospital...

Summary of CMS’s Top 5 Proposed Payment Rules, Revisions

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) has continuously released a steady stream of payment policies and physician fee schedules. As RevCycleIntelligence.com reported in a summary of top 6 previously proposed payment rules and...

Praise for Patient-Centered Payment Models, Bundled Payments

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) apparently gets a big thumbs up this week. Leading consumer advocacy group, the National Partnership for Women & Families (NPWF), openly praises CMS for its efforts regarding patient-centered...

CMS Proposes Post-SGR Repeal Physician Fee Schedule Update

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) has released a projected update to the physician payment schedule. CMS’s proposal marks the first post-Sustainable Growth Rate (SGR) repeal through the Medicare Access and CHIP Reauthorization...

Value-Based Payment Preparation Requires Cost Measurement

by Jacqueline DiChiara

Value-based payments present numerous challenges to healthcare providers. Healthcare finance departments may have a bit of catching up to do. Following an announcement from the Centers for Medicare & Medicaid Services regarding an actively...

July 2: 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...

Burwell Addresses King v. Burwell: ‘Seize This Opportunity’

by Jacqueline DiChiara

The Affordable Care Act (ACA) is simply part of the fabric of America, says Sylvia M. Burwell, Secretary of the Department of Health and Human Services (HHS), during a White House press call mere hours after the monumental King v. Burwell decision...

June 26: 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...

Is Fee-for-Value Payment Reform Transition Merely a Trend?

by Jacqueline DiChiara

As the pendulum swings away from the realm of fee-for-service and into the sphere of fee-for-value, the healthcare industry enters a transitional state where the status quo is becoming merely old news. Those hospitals and physician groups that...

Cigna Rejects Anthem’s ‘Woefully Skewed’ $53.8B Proposal

by Jacqueline DiChiara

The largest ever proposed health insurance merger perhaps falls short. Anthem, Inc announced its submission this week of a highly conditional, non-binding $53.8 billion proposal, including debt, to acquire Cigna Corporation for $184 per share...

CMS’s UDI Claim Form Inclusion Strengthens Medicare Spending

by Jacqueline DiChiara

The simple concept of labeling is a vital yet overlooked aspect of the healthcare industry. More attention to the identification of medical devices as they are distributed and utilized is needed to strengthen the industry’s collective...

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