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

Medicare Spending

End-of-Life Medicare Spending 25% Higher for Younger Seniors

by Jacqueline Belliveau

For most providers, it is not surprising that Medicare spending tends to increase in the last year of a beneficiary’s life, especially since this population is more likely to experience a serious illness and multiple chronic conditions....

Industry Group Advises HHS to Expand Bundled Payment Models

by Jacqueline Belliveau

The Center for American Progress (CAP), a Washington think tank, has called on the federal government to expand bundled payment models in order to further reduce healthcare costs and advance value-based care. The letter to Department of...

CMS Releases Medicare Reimbursement Schedule for DMEPOS Items

by Jacqueline Belliveau

The Centers for Medicare & Medicaid Services (CMS) has released an updated fee schedule for Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), which adjusts Medicare reimbursements to suppliers based on competitive...

OIG: Provider-Based Status Leads to Improper Medical Billing

by Jacqueline Belliveau

The Centers for Medicare and Medicaid Services (CMS) could reduce improper medical billing by eliminating provider-based designations or equalizing payments for the same services provided at different care sites, according to a recent report...

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...

CPC Initiative Improves Care Delivery But Not Medicare Spending

by Catherine Sampson

Although the Comprehensive Primary Care (CPC) initiative lead to progress in primary care delivery, it has not caused improvements in Medicare spending, patient experience or quality of care, researchers from The New England Journal of Medicine...

CMS Plans to Reverse Two-Midnight Rule for Medicare Payments

by Catherine Sampson

On April 18, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that addresses the problematic two-midnight rule that produced 0.2 percent payment reductions for certain hospital inpatient services. The new rule would...

States Could Build Upon the Affordable Care Act to Cut Costs

by Vera Gruessner

The Affordable Care Act has had two main goals for the healthcare system: Increase health insurance coverage for Americans and lower healthcare spending around the country. At this point in time, the Affordable Care Act has brought health coverage...

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...

CMS May Save $343 Million through Surgical Bundled Payments

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) launched the Comprehensive Care for Joint Replacement Model a little more than a week ago. This program is meant to issue bundled payments for a particular episode of care - in this case,...

Affordable Care Act Increases Spending For Newly Insured

by Catherine Sampson

As the Affordable Care Act (ACA) brings more patients into the healthcare system, spending is on the rise, especially on chronic diseases, such as diabetes, heart disease and depression. Blue Cross Blue Shield (BCBS) backs this point in a recent...

Medicare Spending Increases Slightly under Affordable Care Act

by Jacqueline Belliveau

In 2014, Medicare spending for personal healthcare expenditures only increased by 2.4 percent per person and decreased by 3.6 percent for Medicaid, a recent report by the Department of Health and Human Services (HHS) stated. In comparison, overall...

House Budget Proposes ACA Repeal, Reduced Medicare Spending

by Jacqueline Belliveau

The House of Representatives proposed budget plan for 2017 from the House Budget Committee aims to repeal the Affordable Care Act (ACA), reduce Medicare spending, and give states more control with health programs. “With respect to health...

CMS Awards Equipment Contracts to Reduce Medicare Spending

by Jacqueline Belliveau

CMS continues to reduce Medicare spending by awarding contracts to successful bidders for Medicare’s Round 2 and national mail-order recompetes and releasing new single payment amounts for the Durable Medical Equipment, Prosthetics, Orthotics,...

How Medicare Accountable Care Organizations Keep CAHs Afloat

by Jacqueline DiChiara

Medicare accountable care organizations (ACOs) are finally smoothing out regional hospitals' revenue cycle wrinkles. But successful ACOs still need to adopt tighter standards to remain financially viable. Critical access hospitals...

Medicare Advantage Value-Based Care Arrangements Up Revenue

by Jacqueline DiChiara

Healthcare providers have yet to recognize the significant yet untapped potential of Medicare Advantage value-based care arrangements to increase revenue, according to a study from Deloitte.  Health plans are apparently stressed,...

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...

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...

Value-Based Incentives Enrich Accountable Care Organizations

by Jacqueline DiChiara

Pay-for-performance incentives positively sway physician behavior when it comes to value-based care advancement, according to a new JAMA Pediatrics study. Financial incentives tied to value-based reimbursement advance basic health measures,...

Medicare Spending Up, Medicare Shared Savings Requires Risk

by Jacqueline DiChiara

Medicare spending is on the rise as the sizable impact of high-priced drugs on healthcare spending evolves. Accountable Care Organizations (ACOs) appear to be either in, out, or somewhere in between on the financial risk spectrum. Will ACOs take...

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