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

Medicare and Medicaid Services

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...

Pennsylvania Plans for Medicaid Expansion

by Stephanie Reardon

The Medicaid expansion is 100 percent federally funded for the years 2014 through 2016. On February 9, 2015, Governor of Pennsylvania, Tom Wolf announced that the State would be transitioning to a Medicaid expansion plan. This plan will...

Wyoming Rejects Medicaid Expansion with 19-11 Vote

by Stephanie Reardon

Following the negative feedback on the Budget, the bill was rejected with a 19-11 vote and a parallel Medicaid expansion bill was pulled. According to an article by Ruffin Prevost on Reuters, on February 6, 2015, the Wyoming Senate...

Hospitals Oppose Further Medicare and Medicaid Cuts

by Stephanie Reardon

The AHA and other hospital groups wrote a letter to Congress, encouraging them to avoid  Medicare and Medicaid cuts following the repeal of the SGR. The Medicare Sustainable Growth Rate (SGR) has long been a thorn in...

How the 2016 Budget Will Change Medicare and Medicaid

by Stephanie Reardon

2016 Budget plans will have both improvements and challenges for  Medicare and Medicaid providers. On Monday, February 2, 2015, President Barack Obama released the 2016 Federal budget. It reveals plans for saving federal money on...

California State Agency Claims $375,000 in Non-Compliant Medicaid Fees

by Stephanie Reardon

Out of 100 beneficiary-services six had not complied with federal regulations leading to over payment in Medicaid fees. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its audit...

Looking Back on 50 Years of Medicare and Medicaid

by Stephanie Reardon

The Medicare and Medicaid system has evolved along with the healthcare industry. It was a warm day on July 30, 1965 in Washington, D.C. when President Lyndon B. Johnson signed the Social Security Amendments bill into law. This would...

Medicare and Medicaid Cuts One of Many Revenue Problems

by Stephanie Reardon

Medicare and Medicaid pay less for services rendered than private insurance. The Medicaid “fee bump” instated by the Affordable Care Act (ACA) temporarily increased the reimbursement rates for doctors who accepted Medicaid...

EHR Incentive Program Deadline Rapidly Approaching

by Ryan Mcaskill

The deadline for providers to receive payments from the Medicare and Medicaid EHR Incentive Program is February 28. The healthcare industry is just about one month away from the February 28 Eligible Professional attestation Medicare EHR...

Can Increased Medicaid Reimbursements Improve Appointment Availability?

by Stephanie Reardon

Study determined Medicaid appointment availability directly correlated to the size of the Medicaid reimbursement increase implemented by the ACA. The Affordable Care Act (ACA) allows many previously uninsured individuals to get...

New York Faces $1M in Inappropriate Medicaid Claims

by Stephanie Reardon

Nearly $1 million paid in Medicaid claims for beneficiaries who already had these services paid for through managed care plans. The New York State Office of the State Comptroller has released an audit on the Medicaid program department of...

New York State Agency Made $79K in Inappropriate Medicaid Claims

by Stephanie Reardon

State agency claimed Medicaid reimbursement for some home and community-based services provided by New York City providers that did not comply with Federal and State requirements. The Department of Health and Human Service (HHS) Office of...

CMS Administrator Marilyn Tavenner Steps Down

by Ryan Mcaskill

In an email to staff, Tavenner announced that February 2015 will be her last month as head of CMS. There is a major shakeup happening at the Centers for Medicare and Medicaid Services (CMS) as it has been revealed that CMS administrator...

Preventable Readmissions Cost CMS $17 Billion

by Stephanie Reardon

The estimated annual cost of this problem for Medicare is $26 billion annually and $17 billion is considered avoidable. Preventable hospital readmissions are a big part of unnecessary medical spending. According to data from the Center...

CMS Changes Medicare and Medicaid Audit Process

by Stephanie Reardon

CMS paid nearly $4 billion in improper Medicare payments. The Centers for Medicare & Medicaid Services (CMS) announced that it has expanded its contracts to four different companies – HealthDataInsights, CGI Federal, Connolly...

What Happens When Medicaid Expansion Goes Wrong?

by Stephanie Reardon

State officials terminated a $118.3-million contract with Hewlett-Packard for failure to implement a functional eligibility system to aid Medicaid expansion in New Jersey. As part of the launch of the Affordable Care...

Medicare Payments Reduced for Hospital-Acquired Conditions

by Stephanie Reardon

721 hospitals will face a one-percent reduction in Medicare payments from the federal government. Despite incentives for hospitals to reduce hospital-acquired conditions (HACs), 721 hospitals will face a one-percent reduction in Medicare...

Over $400K in Medicare Reimbursed

by Stephanie Reardon

Boone Hospital did not fully comply with Medicare billing requirements, resulting in overpayments of $407,495. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its audit on...

14K in Unallowable Excess Plan Costs Claimed for Medicare

by Stephanie Reardon

TrailBlazer claimed $14,114 in unallowable fiscal intermediary and carrier contract Excess Plan costs. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its audit on TrailBlazer...

Hospital Overpaid $110,943 in Medicare Claims

by Stephanie Reardon

OIG audit discovered  the Hospital did not fully comply with Medicare billing requirements, resulting in $110,943 overpayment in Medicare claims. The Department of Health and Human Service (HHS) Office of Inspector General (OIG)...

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