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

Medicare Spending

HHS Launches Health Care Payment Learning and Action Network

by Jacqueline DiChiara

The Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell met with President Obama to launch the Health Care Payment Learning and Action Network. An estimated 2800 payers, providers, employers, patients, states,...

National Health Spending Reached $2.9T in 2013

by Ryan Mcaskill

The latest report shows healthcare spending has reached $2.9 trillion in 2013 at a growth rate of 3.6 percent. Healthcare is a trillion dollar a year business and the latest numbers show that in 2013, the total national health...

Inpatient Volume, Revenue Drops as Outpatient Care Makes Gains

by Jennifer Bresnick

Hospitals must find ways to leverage outpatient service opportunities as a reduction in inpatient volume leaves a trail of empty beds. Inpatient volumes, and the revenues from hospital admissions, are dropping rapidly as the healthcare...

Ex-Hospital CEO, Doctors Guilty of $400M in Medicare Fraud

by Jennifer Bresnick

A number of different racketeers have been convicted of more than $400 million in fraudulent Medicare billings. The Attorney General’s Office has quashed a number of different high-value Medicare fraud schemes, and has convicted or...

Are Medicare Health Plans Improving or Getting Weaker?

by Elizabeth Snell

With Medicare’s open enrollment period starting tomorrow and running through December 7, the debate is on over the success of Medicare health plans. Critics are upset that the same deficiencies keep happening, while the Centers for...

OIG: Medicare Contractor Erred in Two Reimbursement Claims

by Elizabeth Snell

One Medicare contractor was found by the Office of the Inspector General (OIG) to have made errors in two different aspects of the filing of its Medicare reimbursement claims. First, the National Heritage Insurance Company (NHIC) claimed...

HHS: Medicare Part B Premiums, Deductibles Staying the Same

by Elizabeth Snell

Healthcare costs are often a top concern for providers and patients. However, one expense is remaining the same for the second year in a row. Next year’s Medicare Part B premiums and deductibles will remain the same as the last...

Outpatient Costs Higher for Rural Hospital Medicare Patients

by Ryan Mcaskill

A new report from the inspector general at the Department of Health and Human Services (HHS), found that medicare beneficiaries treated at primary rural “critical access” hospitals (CAHs) pay more for outpatient services than...

How Easily Can Seniors Access Medicare Preferred Pharmacies?

by Elizabeth Snell

Regardless of whether older Americans live in small towns or rural areas, the majority of them are still able to find access to preferred pharmacies in Medicare, according to a recent survey. Specifically, 9 in 10 seniors from urban,...

Medicare Readmission Penalties Hit 2,610 Hospitals

by Elizabeth Snell

Medicare fined 2,610 hospitals across the nation for readmission penalties, according to a report released last week. This is a record number of hospitals being fined for having patients returning within one month for additional...

CMS Releases First Set of Open Payments Data

by Elizabeth Snell

The Centers for Medicare & Medicaid Services (CMS) released the first round of Open Payments data this week. The move is part of a larger effort to help consumers understand the financial relationship between the health care industry,...

Will integrated Medicare and Medicaid benefits save money?

by Elizabeth Snell

Individuals who are disabled, under the age of 65 and qualify for both Medicare and Medicaid benefits are known as disabled dual-eligible beneficiaries. In 2009, the Medicare and Medicaid programs spent an estimated $103 billion...

ACO payment reform proposed in new legislation

by Elizabeth Snell

Two state representatives introduced legislation earlier this month in an effort to further advance the progress of Accountable Care Organizations (ACOs). Representatives Diane Black (R-TN) and Peter Welch (D-VT) explained in a joint...

CMS releases FY2013 RAC report to Congress

by Elizabeth Snell

The Center for Medicare & Medicaid Services (CMS) released its Medicare fee-for-service Recovery Audit Program’s report to Congress for fiscal year 2013. The report found that Recovery Audit Contractors (RACs) identified and...

Safeguards possibly ineffective on some copayment coupons

by Elizabeth Snell

Pharmaceutical manufacturers’ current safeguards may not prevent all copayment coupons from being used for drugs paid for by Part D, according to a recent Office of Inspector General (OIG) report. The coupons are typically offered...

Texas legislator asks Medicare to retract billing settlement

by Elizabeth Snell

Typically, settling disputed inpatient billing claims is seen as a positive thing. However, the chairman of the House Ways and Means Committee’s health panel believes that Medicare’s current plans to do so could result in...

Medicare ACOs improve care, save $372M in healthcare costs

by Elizabeth Snell

Medicare Accountable Care Organizations (ACOs) improved patient care and generated over $372 million in total program savings, according to the Center for Medicare & Medicaid Services (CMS). The Medicare Shared Savings Program (MSSP)...

Are Part B Rx drug rates higher than other gov’t programs?

by Elizabeth Snell

Medicare Part B lost millions of dollars in 2011 because certain fees were not aligned with the rates that Part D and state Medicaid programs paid, according to a recent Office of Inspector General (OIG) report. Specifically, if Part B...

Research finds higher Medicare spending in unhealthy states

by Elizabeth Snell

Socioeconomic factors that affect the need for medical care, along with interactions between the Medicare system and other parts of the health system are main reasons why there is variation in Medicare health spending between states,...

2015 proposed physician fee schedule, Part B revisions

by Elizabeth Snell

On Friday, July 11, 2014, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule for its “Revisions to Payments Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B”...

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