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

Medicare and Medicaid Services

Is Data Collection too Burdensome in CMS Final Payment Rule?

by Jacqueline DiChiara

A new 311 page final rule from the Centers for Medicare & Medicare Services (CMS) aims to amend the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system. CMS’s...

Why are Incorrect Characters a Top ICD-10 Coding Challenge?

by Jacqueline DiChiara

Lack of training for inpatient procedural coding may pose a significant challenge for the healthcare industry as 2015 comes to a close, said Teri Jorwic, ICD-10 Educator and Professor of Healthcare Informatics at the University of Illinois at...

Humana Pays Physician Groups $77M for Value-Based Outcomes

by Jacqueline DiChiara

As the fee-for-service realm dissipates and the value-based reimbursement model nears its completed transition in coming years, Humana is granting sizable financial rewards for those physician groups yielding quality care outcomes....

November 13: 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...

GAO to CMS: State Medicaid Payment Flaws Hurt Transparency

by Jacqueline DiChiara

The reliability regarding tens of billions of dollars in states’ supplemental payments is being called into question this month by the United States Government Accountability Office (GAO). Because complete reliable data is deficient, transparency...

CMS Reports ACOs Assume High Risk Yet Generate High Savings

by Jacqueline DiChiara

Accountable care organizations (ACOs) generated over $411 million in net program savings last year, according to financial and quality performance results from the Centers for Medicare & Medicaid Services (CMS). “The Affordable Care...

GAO Reports Inadequate CMS Federal Exchange Coverage Control

by Jacqueline DiChiara

Insufficient and inadequate policies and procedures from the Centers for Medicare & Medicaid Services (CMS) require greater levels of federal control to maintain effectiveness, says a report from the United States Government Accountability...

Healthcare Consumers Demand More Coverage Comparison Options

by Jacqueline DiChiara

A new pilot initiative involving a “Doctor Lookup” feature is now available for some healthcare consumers’ online perusal. Such a beta feature lets healthcare consumers compare coverage options in association with their individual...

November 6: 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 Home Health Agencies Face Upcoming Payment Changes

by Jacqueline DiChiara

The Medicare home health prospective payment system (HH PPS) can expect payment changes next year, confirms an announcement from the Centers for Medicare & Medicaid Services (CMS). These payment changes aim to ensure greater payment...

Cigna-HealthSpring, UPHS Confirm Network Expansion Agreement

by Jacqueline DiChiara

Cigna-HealthSpring and The University of Pennsylvania Health System (UPHS) have announced new collaboration efforts to expand a 2016 network relationship agreement and provide supplementary resources and a series of well-coordinated incentives....

CMS Proposed Rule Modernizes Discharge Planning Requirements

by Jacqueline DiChiara

Patient preferences require more adequate attention and addressing, says the Centers for Medicare & Medicaid Services (CMS). Long-term care hospitals, inpatient rehabilitation facilities, critical access hospitals, home health agencies, and...

CMS Final Rule Improves Medicaid Beneficiaries’ Care Access

by Jacqueline DiChiara

The Centers for Medicare & Medicaid Services (CMS) has released a final rule – effective on January 4, 2016 – that aims to advance the way covered services are measured and strengthen Medicaid beneficiary protection and care access....

October 30: 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...

Do Medicare Shared Savings Program Final Waivers Boost ACOs?

by Jacqueline DiChiara

Laws that restrict financial arrangements between hospitals, physicians, beneficiaries, and the like are on the immediate horizon, according to newly published regulation from the Centers for Medicare & Medicaid Services (CMS), the Office...

Medicare Advantage Members Report High Plan Satisfaction

by Jacqueline DiChiara

Medicare Advantage members confirm greater levels of plan satisfaction than those enrolled in commercial programs, says a 2015 Medicare Advantage Member Satisfaction Study released by J.D. Power. A well-informed patient who...

HHS Backs Behavioral Health with $23M Grant Funding Efforts

by Jacqueline DiChiara

The Substance Abuse and Mental Health Services Administration (SAMHSA) – in partnership with both the Centers for Medicare & Medicaid Services (CMS) and the Assistant Secretary of Planning and Evaluation (ASPE) – will award up...

CMS Releases Sec. Burwell’s Section 1115 Congress Report

by Jacqueline DiChiara

A report to Congress – The Secretary's First Annual Report on Transparency in the Review and Approval of Section 1115 Demonstration (Amendments to the Social Security Act (SSA) and Title II of this Act) – was recently...

October 16: 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...

GAO: CMS MA Efforts Fail to Uphold Provider Network Adequacy

by Jacqueline DiChiara

The Administrator of the Centers for Medicaid & Medicaid Services (CMS) should make adjustments to the management of Medicare Advantage (MA) networks to tackle provider availability, validate MA organizations’ (MAO) provider information,...

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