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

Medicare and Medicaid Services

CMS Tackles Medicare Spending, Medicaid Financial Incentives

by Jacqueline DiChiara

Medicare and Medicaid spending demands closer alignment for healthcare providers to better manage costs, according to a new report from the Centers for Medicare & Medicaid Services (CMS). A CMS/state partnership Capitated...

CMS Final Rule Revises Medicaid Reimbursement, Drug Rebates

by Jacqueline DiChiara

Medicaid reimbursement improvements are underway, according to a final rule from the Centers for Medicare & Medicaid Services (CMS). The rule – CMS-2345-FC – provides greater detail about Medicaid reimbursement and rebate calculation....

Why Flawed Alternative Payment Model Design Holds MACRA Back

by Jacqueline DiChiara

Alternative Payment Models (APMs) do not adequately address payment system problems, according to a new report from the Center for Healthcare Quality and Payment Reform (CHQPR). Healthcare payment reform is apparently progressing at a snail’s...

CMS Makes Revisions to Medicare Prospective Payment System

by Jacqueline DiChiara

The Centers for Medicare and Medicaid Services (CMS) is making changes to the Medicare hospital inpatient prospective payment systems (IPPS). CMS says it is modifying 2016’s IPPS Pricer to reflect a new payment calculation adjustment...

CAPG Praises Next Generation Accountable Care Organizations

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) recently selected twenty-one healthcare organizations to participate in a newfangled Next Generation Accountable Care Organization (ACO) model. The 21 participating ACOs have formidable...

55 Hospitals File Two-Midnight Rule Lawsuit Against HHS

by Jacqueline DiChiara

The healthcare industry is burning the two-midnight oil. Fifty-five hospitals filed a lawsuit last Friday against the Department of Health and Human Services (HHS) regarding the two-midnight rule’s 0.2 percent inpatient compensation...

CMS’s Medicare Drug Spending Dashboard Notes Spending Spike

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) has released a Medicare Drug Spending dashboard to address prescription drugs’ affordability. CMS aims to make drug spending trends more transparent for healthcare providers. CMS...

AMA, CMS Lead Discussion on Evolving Healthcare Market Today

by Jacqueline DiChiara

The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) are pairing up to lead a discussion today about the ongoing state of the evolving healthcare market. The discussion will be held at 5PM (PT) at...

CMS, HHS Get Social with $157M in Medicare, Medicaid Funding

by Jacqueline DiChiara

The Department of Health and Human Services (HHS) has revealed a new 5-year $157 million funding opportunity this week to help advance the overall quality and affordability of Medicare and Medicaid. The health-related social needs of Medicare...

CMS Tackles Value-Based Purchasing Pilot Program Questions

by Jacqueline DiChiara

Competition across the nation for value-based payment incentives is underway with the start of a new year. Nine states, each representing a different geographic region, have implemented the home health value based purchasing pilot program...

CMS Says Information Technology Builds Healthcare Delivery

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) is beginning the New Year with a happy and healthy resolution tied to the significance of health information technology (IT). CMS declared in an official blog post last Wednesday that it...

Why the Value-Based Care Journey Begins with Assessment

by Jacqueline DiChiara

How to find value in the value-based care reimbursement movement is one goal the healthcare industry will likely be striving for in 2016. As Medicare, Medicaid, and commercial health plans continue to press hospitals and physicians to implement...

A Very Happy New Year from!

by Jacqueline DiChiara

2015 was The Year of ICD-10. News of grace period delays, deadline extensions, claims management woes, and discussions about a proposed freeze topped our most popular articles of the year. “The long-awaited U.S. transition to...

2015: Year That Was in Healthcare Fraud and Malpractice

by Jacqueline DiChiara

Here is a general roundup of the past year’s developments in healthcare fraud and malpractice, as reported by the Department of Justice and the Office of Inspector General (OIG). The crimes reported below result in multiple millions of...

How a Palliative Care Focus Eases Healthcare’s Cost Burdens

by Jacqueline DiChiara

As physicians across the country mull over their New Year’s resolutions this week, the overarching desire for a healthy revenue cycle will likely be a common theme. Physicians often struggled with how to keep money flowing as easily as New...

How Advanced Care Discussions Impact Provider Payment Focus

by Jacqueline DiChiara

Critical end-of-life discussions between a physician, a patient, and a patient’s family or loved ones, are perhaps being glossed over more and more because of reimbursement challenges. The Centers for Medicare & Medicaid Services (CMS)...

CMS’s Quality Measurement Development Plan Supports MIPS, APM

by Jacqueline DiChiara

2016 may be an especially good year for healthcare providers when it comes to matters of revenue cycle management. The Centers for Medicare & Medicaid Services (CMS) recently posted a 63-page Measure Development Plan, a strategic framework...

How CMS’s Proposed IMPACT Act Impacts Healthcare Providers

by Jacqueline DiChiara

Every patient who steps foot into a hospital – from the college quarterback with a broken collarbone to the octogenarian diagnosed with numerous comorbidities – may soon require a discharge plan, according to a new proposed rule from...

CMS Releases Fee-for-Service Data for Home Health Agencies

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) is striving once again to make the healthcare industry more  transparent, affordable, and accountable with the dissemination of free-flowing information. CMS has released...

Why HOPD Medicare Expenditures Need Equalized Payment Rates

by Jacqueline DiChiara

Medicare expenditures for hospital outpatient departments (HOPD) services are apparently on the rise, especially in recent years. A new report to Congressional requesters from the United States Government Accountability Office (GAO) examines...


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