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

Primers

Exploring Virtual Groups in the Quality Payment Program, MIPS

October 4, 2018 - Virtual groups enable independent physicians and clinicians in small practices to participate in Medicare’s historic push to transition to value-based reimbursement: the Quality Payment Program. The Quality Payment Program, or QPP, aims to shift the industry away from fragmented fee-for-service payments to a system that reimburses clinicians based on the value of the care they...


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Exploring the Bundled Payments for Care Improvement Advanced Model

by Jacqueline LaPointe

CMS recently unveiled the Bundled Payments for Care Improvement (BPCI) Advanced initiative, a new bundled payments model that will include inpatient and outpatient clinical episodes and qualify as an Advanced Alternative Payment Model...

Exploring Key Components of the Healthcare Revenue Cycle

by Jacqueline LaPointe

The healthcare revenue cycle encompasses “all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue,” according to the Healthcare Financial Management...

3 Pain Points Affecting Small Practice Healthcare Revenue Cycle

by Jacqueline LaPointe

While working in a small practice allows providers to really understand their patients and their community’s healthcare needs, it can also create unique healthcare revenue cycle management challenges. Small practices come with...

Top 4 Patient Financial Responsibility Collection Methods

by Jacqueline LaPointe

The top priority for providers is to deliver high-quality healthcare services to their patients. But the recent rise in patient financial responsibility and healthcare consumerism has forced some providers to bump patient collections to...

Exploring MIPS Advancing Care Info, Improvement Activities

by Jacqueline LaPointe

At HIMSS17, CMS leaders took the stage to ease provider concerns about the newly launched Quality Payment Program and its more popular value-based reimbursement track, the Merit-Based Incentive Payment System (MIPS). Following up on their...

Exploring the Role of Supply Chain Management in Healthcare

by Jacqueline LaPointe

Cutting healthcare costs has become a mantra for many hospitals and physician practices, especially as payers start to tie claims reimbursement amounts to quality and cost performance. Many organizations have looked to the billing and...

Examining the Role of Financial Risk in Value-Based Care

by Jacqueline LaPointe

As the healthcare industry ramps up its efforts to advance value-based care, providers are expected to take on more financial risk. One of the goals of value-based care is to transition financial risk away from taxpayers and healthcare...

Understanding the Basics of Bundled Payments in Healthcare

by Jacqueline LaPointe

The shift to value-based care has driven public and private payers to redesign reimbursement models that stress accountability for care quality and healthcare costs. As the fee-for-service environment fades away, alternative payment models...

CMS Extends Deadline for Bundled Payment Models Participation

by Vera Gruessner

The federal government especially the Centers for Medicare & Medicaid Services (CMS) have long focused on reducing healthcare spending and implementing alternative payment models such as pay-for-performance initiatives. Bundled payment...

Defining the Top 10 Terms of Healthcare Revenue Cycle Management

by Catherine Sampson

In some cases, definitions for terms and acronyms related to healthcare revenue cycle management can come across as fairly straightforward. Other times, they can sound more like a foreign language. A healthcare professional may find it...

ICD-10 System Codes Will See New Updates by October 1

by Vera Gruessner

The ICD-10 implementation deadline and postponements brought a variety of challenges to the healthcare field. One of those obstacles has been the constant ICD-10 system code freezes. However, on October 1, 2016, the healthcare industry...

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...

Does Medicaid Expansion Improve Revenue of Hospitals?

by Vera Gruessner

The Affordable Care Act and Medicaid expansion has had a significant impact on hospitals around the country since full coverage for millions of Americans would lead to greater utilization of healthcare services and possibly strain the...

CMS, CDC Add More than 5,000 Codes to ICD-10 Coding System

by Vera Gruessner

Last week, the Centers for Disease Control and Prevention along with the Centers for Medicare & Medicaid Services (CMS) announced some major news for the ICD-10 coding system. The two organizations have added more than 5,000 new ICD-10...

CMS Awards Equipment Contracts to Reduce Medicare Spending

by Jacqueline LaPointe

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,...

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...

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...

HHS Proposes Rule Endorsing Nondiscriminatory Gender Equity

by Jacqueline DiChiara

The Affordable Care Act’s (ACA’s) handling of civil rights matters is under fresh review. The Department of Health and Human Services (HHS), seeking to advance health equity under the ACA, issued a proposed rule last week...

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,...

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