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

Medicare Reimbursement

AHA Seeks Changes to Post-Acute Care Medicare Reimbursement

by Jacqueline Belliveau

The American Hospital Association (AHA) has called on the Centers of Medicare and Medicaid Services (CMS) to revise proposed Medicare reimbursement reforms for two post-acute care models. In separate letters, the AHA outlined several issues with...

CMS Updates Medicare Reimbursement Schedule for Lab Tests

by Jacqueline Belliveau

A new methodology for calculating Medicare reimbursement rates for laboratory tests is on the horizon, according to a fact sheet from the Centers of Medicare and Medicaid Services (CMS). According to a final rule issued this week, Medicare reimbursement...

New DMEPOS Prices Reduce Medicare Spending, Ensure Care Access

by Jacqueline Belliveau

Riding on the success of the competitive bidding program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), CMS has announced that expanding competitive bidding prices for DMEPOS items nationwide has continued to reduce...

Rural Hospitals May Get Senate Help with Medicare Reimbursements

by Catherine Sampson

As the healthcare industry shifts from volume to value, hospitals are expected to provide quality care as many could also potentially face lower Medicare reimbursements. At the same time, many hospitals in rural and economically distressed areas...

How to Reduce Wasteful Spending in the Medicare Program

by Vera Gruessner

When the Affordable Care Act was passed several years ago, it had major implications for the future of the Medicare program. According to a study from the Private Enterprise Research Center at Texas A&M University, the Affordable Care Act...

Value-Based Care Reimbursement Needs Greater Customization

by Vera Gruessner

With rising healthcare spending found throughout the US, the federal government has put greater focus on value-based care reimbursement than ever before. Healthcare providers and payers are seeking ways to move beyond fee-for-service payment...

CMS Proposes New Healthcare Payment Models for Medicare Part B

by Vera Gruessner

New healthcare payment models are being advised by the Centers for Medicare & Medicaid Services (CMS). From alternative payment models to the Medicare Shared Savings Program and the Comprehensive Care for Joint Replacement program, the federal...

Revenue Cycle Management Success is About the Fundamentals

by Jacqueline DiChiara

Revenue cycle management success is the heart of any healthcare organization. Defined as the clinical and administrative management of claims management, payment, and revenue production, revenue cycle management is in essence one large financial...

CMS Reports SNF Payment Incentives May Cut Medicare Spending

by Jacqueline DiChiara

Medicare spending is falling, according to an annual report from the Centers for Medicare & Medicaid Services (CMS) that assessed how to reduce avoidable hospitalizations for long-stay nursing facility residents. Well-targeted...

What Are the Greatest Revenue Cycle Management Challenges?

by Jacqueline DiChiara

RevCycleIntelligence.com recently polled over 60 readers to assess revenue cycle management challenges and opportunities, from the front-end, to the back-end, and everything in between. Readers said collecting payment from a patient in a timely...

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...

HHS, CMS Speak Out on CMS’s Innovation Center Pilot Project

by Jacqueline DiChiara

Medicare reimbursements are preparing to emerge from a fee-for-service caterpillar’s cocoon to a value-based butterfly. The newly announced Accountable Health Communities [AHC] model – a CMS Innovation Center Pilot...

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)...

Top 6 Trending Payment Models Demanding New Long-Term Focus

by Jacqueline DiChiara

Time is money, especially when it comes to healthcare. Paying for outcomes gained instead of mere services rendered is the new name of the healthcare game. This means the simple notion of paying for multiple physician visits, medical...

CMS Announces Two-Midnight Payment Cut Commentary Period

by Jacqueline DiChiara

A notice and accompanying commentary period released yesterday from The Centers for Medicare & Medicaid Services (CMS) examines the core issue behind slashing hospital inpatient payments by 0.2 percent. This financial cut is tied to a “two-midnight...

Why Value-Based Care Yields Lower Cost, Higher Quality Care

by Jacqueline DiChiara

Value-based care is in the lead compared to its fee-for-service competitor, according to Humana’s new Medicare Advantage population health results. “Members treated under the care of providers in value-based reimbursement models with...

Are Medicare Pay-for-Performance Benefits Worth the Risk?

by Jacqueline DiChiara

Medicare pay-for-performance (P4P) incentives are inadvertently averting money away from those financially aching hospitals primarily serving minorities and the economically disadvantaged to instead inflate the revenues of those hospitals serving...

How to Rescue Revenue Cycle with Medicare Appeals Pending

by Jacqueline DiChiara

The rehabilitation needs of Medicare beneficiaries within the state of California may be in jeopardy. Payment for hundreds of thousands of claims for services is being denied. Most of these denials are reportedly invalid, confirms past appeal...

HHS Urged to Resolve Pending Medicare Appeals in Filed Suit

by Jacqueline DiChiara

Casa Colina Hospital and Centers for Healthcare recently filed suit to require timely Medicare patient care appeals mandated under federal law.  The Medicare program is denying payment for hundreds of thousands of claims for services....

Readers Debate the Affordable Care Act’s Anticipated Impact

by Jacqueline DiChiara

Is the Affordable Care Act (ACA) a beautiful success, a gut-wrenching failure, or a complexly vague combination of both? Simply put, opinions are mixed. Some across the healthcare industry confirm various ACA successes – more uninsured...

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