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

Medicare and Medicaid Services

Medicaid Providers Struggling to Raise Reimbursement Rates

by Jacqueline DiChiara

Medicaid providers seeking to raise their reimbursement rates by suing the government are essentially out of luck, according to documentation within a recent Supreme Court ruling. “The notion that respondents have a right to sue,”...

Has the Affordable Care Act Led to a Slowdown in Premiums?

by Jacqueline DiChiara

Slow and steady appears to be the financial mantra echoing forth within the healthcare industry. There has been a distinct deceleration in premium growth within the past three years following the implementation of Affordable Care Act...

April 3: 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. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility...

CMS Announces Possible Delay as Medicare Doc Payment Begins

by Jacqueline DiChiara

The Bipartisan Permanent Sustainable Growth Rate (SGR) Fix and Children’s Health Insurance Program (CHIP) Reauthorization Package replaces the flawed Medicare formula as a “doc-fix.” This legislation aims to transition...

Will Cost Shifting Drive Support for Larger Public Payments?

by Jacqueline DiChiara

Speculation abounds around whether hospitals’ decisions to increase the prices charged to commercially insured individuals to compensate for decreased Medicare reimbursement via cost shifting will reduce the healthcare industry’s...

Why Is Medicaid Expansion a Win for Healthcare Providers?

by Jacqueline DiChiara

As anyone standing before a plate of freshly baked desserts or fearfully opening a credit card bill post online shopping binge can attest, the art of equilibrium is essential. This idea of balance is also needed within the financial realm of...

Declining Accountable Care Organizations Represent Expansion

by Jacqueline DiChiara

The dawn of 2015 for the healthcare industry began with the Centers for Medicare & Medicaid Services (CMS) announcing an additional 89 provider organizations enrolling in the Medicare Shared Savings Program (MSSP) as accountable care organizations...

Quantify Denial Rates for Smooth Revenue Cycle Management

by Jacqueline DiChiara

A hospital or medical practice’s ability to swiftly and economically process claims and quantify denial rates is critical to ensure smooth revenue cycle management and medical reimbursement. The ability to accurately predict reimbursement...

Bipartisan House Repeals Medicare SGR Before Senate Vote

by Jacqueline DiChiara

There are possible new improvements to the Medicare Sustainable Growth Rate (SGR) payment system today as the bipartisan House of Representatives overwhelmingly passed the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2). This legislation...

Congress Debates Economic Benefits of EHR Incentive Programs

by Jacqueline DiChiara

The Electronic Health Record (EHR) Incentive Programs are failing to prove economically beneficial and impose unreasonable mandates on providers according to members of the Senate Health, Education, Labor and Pensions Committee hearing on Health...

AMA President Urges Physicians Prepare for ICD-10 Transition

by Jacqueline DiChiara

A recent letter from the American Medical Association (AMA) and 99 other physician groups to the Centers for Medicare & Medicaid Services (CMS) expressed collective concern that effective contingency plans require further completion to prevent...

High Critical Access Hospital Reimbursement Costs Medicare

by Jacqueline DiChiara

Swing-bed services provided at 90 percent of critical access hospitals (CAHs) could have been avoided by use of neighboring alternative facilities during 2010, reports the Office of Inspector General (OIG). If swing-bed services at CAHs —...

Medicare Advantage Average Payment Cut Hurts Beneficiaries

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) proposes to slash Medicare Advantage (MA) and Medicare Part D (MAPD) plan payments next year by an average payment cut of .95 percent, as stated in February’s 2016 Calendar Year (CY)...

Does 2015 ICD-10 Transition Mean Millions in Unpaid Claims?

by Jacqueline DiChiara

A hundred physician groups, including the American Medical Association (AMA), expressed strong trepidation regarding the potential for a dangerous accumulation of millions of dollars in unpaid Medicare claims when the ICD-10 transition goes into...

GAO Recommends Changes to Medicaid Reimbursement Technology

by Jacqueline DiChiara

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 information technology (IT) and Medicaid...

Medicaid Acceptance, Payment Rates Both on the Decline

by Jacqueline DiChiara

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 Medicaid acceptance. More intervention...

Telehealth Reimbursement Needed for its Growth, Advancement

by Jacqueline DiChiara

An increasingly digitalized healthcare system has experienced significant telehealth reimbursement changes — even within the past five years — as it becomes more routinely integrated. The snowballing demand for telehealth solutions...

Does Successful ICD-10 Testing Mean a Smooth Transition?

by Jacqueline DiChiara

The International Classification of Diseases (ICD) is used to standardize codes for medical conditions and procedures. The Centers for Medicare & Medicaid Services (CMS) is assisting and supporting industry stakeholders with the October 1,...

Feb. 20: Week That Was in Healthcare Fraud, 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. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility...

Medicaid Expansion in Nebraska and Kansas

by Stephanie Reardon

With 29 states and DC having already opted to expand their Medicaid coverage, other states are aiming to join the trend. The decision to expand Medicaid continues to be a legal struggle for many states. The decision could substantially...

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