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

Medicare and Medicaid Services

May 1: 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...

Medicare Smart Card Technology a Cost Benefit to Healthcare?

by Jacqueline DiChiara

Whether you check the time on your smart phone, smart watch, or an only moderately intelligent clock radio, the realm of all things electronically stimulating is indubitably interwoven into the fabric of all technological facets within the healthcare...

Top Six Proposed Physician Fee Schedules, Payment Policies

by Jacqueline DiChiara

The healthcare industry awaits the possibility of great financial policy adjustment in the immediate future due to a continuous stream of announcements from The Centers for Medicare & Medicaid Services (CMS) regarding various proposed rules...

April 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...

Revenue Cycle Management as Return on Investment

by Jacqueline DiChiara

Consider for a brief moment a patient's numbing fear stemming from unexpected sticker shock when perusing a medical bill’s enigmatic extra zeros or from receiving a hefty stack of unforeseen payment requests post-service. ...

CMS Extends $3B Medicaid Eligibility and Enrollment Funding

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule on April 16, 2015 to extend access to enhanced federal financial participation for Medicaid eligibility and enrollment (E&E) systems beyond the formerly implemented...

Physician-Led ACOs Need Opportunities to Thrive

by Jacqueline DiChiara

Many of the HIMSS15 educational sessions this week in Chicago offered valuable insight into the financial future of the healthcare industry. Farzad Mostashari, MD, ScM, Aledade Inc. Founder and CEO and former National Coordinator...

April 17: 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...

Mechanized Claims Processing the Future of Medicaid?

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) present a proposed rule to extend enhanced federal financial participation for Medicaid eligibility and enrollment systems beyond the...

AMA CEO: Flawed SGR No Longer Threatens Payment Delivery

by Jacqueline DiChiara

James L. Madara, MD, Chief Executive Officer and Executive Vice President of the American Medical Association (AMA), provided insight via a morning media conference today on the organization’s perspective regarding the Senate’s overwhelmingly...

$100B Aftermath of Medicare Access, CHIP Reauthorization Act

by Jacqueline DiChiara

The ongoing push for value-based reimbursement endures with the finalization of new legislative decisions regarding the permanent SGR repeal's ripple effect on the healthcare industry at large. The Medicare Access and CHIP...

Permanent SGR Repeal, Physician Medicare Fees Overhauled

by Jacqueline DiChiara

The Senate, in conjunction with the House of Representatives, has approved the Sustainable Growth Rate (SGR) repeal to replace it with the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2). The Senate overwhelmingly voted 92 to 8...

Medicare Physician Fee Schedule Updated with SGR Methodology

by Jacqueline DiChiara

Medicare’s Physician Fee Schedule (MPFS) is associated with an inflation algorithm that has been criticized for not paying physicians enough to be able to effectively administer quality care to Medicare beneficiaries. MPFS was...

New WEDI Focus on Bundled Payments, Value-Based Initiatives

by Jacqueline DiChiara

The Workgroup for Electronic Data Interchange (WEDI) recently announced its Payment Models Workgroup is forming a new project team committee – the Bundled Payments Taskforce – to more closely examine bundled payments and various value-based...

April 10: 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 QIO Progress Report Promotes Quality in Medicare Program

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services’ (CMS) Quality Improvement Organization (QIO) Program published the 2014 QIO Progress Report. The QIO Program is a leading federal program committed to ensuring Medicare beneficiaries consistently...

Costly Impact of CMS’ Mental Health Parity Rule on Medicaid

by Jacqueline DiChiara

Expensive treatment for a mental health or substance use disorder often means imposed limitations in insurance coverage. Medicaid programs may soon carry the burden of alleviating such costs. The Centers for Medicare & Medicaid Services (CMS)...

CMS Delays Two-Midnight Rule, Medicare Claims Now Pending

by Jacqueline DiChiara

The ongoing financial debate between hospitals and physicians about what differentiates an inpatient from an outpatient in terms of administered payment after the stroke of midnight (or two) continues to evolve. The Centers for Medicare...

Does ACA Boost Physicians’ Medicaid Participation?

by Jacqueline DiChiara

Medicaid beneficiaries are keeping the doctor away. Newly released data may offer a fresh industry-wide perspective about how often physicians accept Medicaid regarding delayed implementation stemming from the Affordable Care Act’s (ACA’s)...

SGR Repeal Requires New Focus on Quality Measurement

by Jacqueline DiChiara

In a landslide vote of 392 to 37, the House of Representatives passed legislation last week to permanently repeal the Sustainable Growth Rate (SGR) designed to limit the increase of Medicare physician payments that has proven highly problematic...

Continue to site...