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

Policy & Regulation News

Lack of Medicaid Expansion Leads to Hospital Revenue Loss


Ever since a number of states refused to expand their Medicaid programs and receive the majority of funding for this enterprise from the federal government, there has been a division of revenue between states that have broadened Medicaid coverage...

CMS Demonstrates How to Track ICD-10 Implementation Progress


CMS has recently released an infographic urging healthcare providers to assess and analyze their ICD-10 progress by identifying key performance indicators (KPIs) and creating baselines for analysis for each KPI. The recent announcement highlights...

3 Key Steps to Continue ICD-10 Implementation Progress


Now that the ICD-10 implementation has been deemed a relative success throughout the healthcare industry, the Centers for Medicare & Medicaid Services (CMS) are focused on continuing the progress related to the ICD-10 implementation. CMS...

Value-Based Reimbursement May Not Bring Benefits for SNF Care


CMS has released the Skilled Nursing Facility Utilization and Payment Public Use File, a dataset on the care skilled nursing facilities (SNF) provided to Medicare beneficiaries in 2013.  The data raises questions about the effect of...

CMS Proposes New Healthcare Payment Models for Medicare Part B


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...

Medicaid Program Advances Patient Engagement, Interoperability


At the HIMSS16 conference in Las Vegas, the Centers for Medicare & Medicaid Services (CMS) will be presenting a discussion revolving around how health IT applications could incentivize patient engagement. The panel discussion will incorporate...

ICD-10 Claim Denial Rate Remains Low among Most Providers


It seems that the ICD-10 implementation has not had a very negative effect on the ICD-10 claim denial rate, which hasn’t risen much since the October 1 deadline. For example, RelayHealth Financial, a revenue cycle management solutions provider,...

CMS Releases Post-ICD-10 Claims Denial Reimbursement Metrics


Post-ICD-10 implementation claims denial is a top 2016 focus for healthcare organizations. According to last month’s ICD-10 survey from Porter Research and Navicure, healthcare organizations cite value-based care as a leading focus. Sixty...

Medicaid Expansion Decisions Cost Hospitals, States Billions


Medicaid expansion rejection is costing various states across the nation a great deal of money. The voluntary decision to not implement Medicaid expansion is potentially harmful for revenue cycle management. Expansion states have been experiencing...

Examining the Value-Based Alternative Payment Model Basics


Alternative payment models like the accountable care organization (ACO) and the bundled payment model have been gaining popularity under the Affordable Care Act’s (ACA) mandates. Figuring out how alternative payment models will evolve under...

CMS Provider Data Combats Medicare, Medicaid, CHIP Fraud


To help combat healthcare fraud, the Centers for Medicare & Medicaid Services (CMS) has released a new pair of public data sets to promote greater Medicare and Medicaid data transparency and cut down on Medicare and Medicaid fraud,...

Price Transparency Still Missing from Hospital Revenue Cycle


The Affordable Care Act’s (ACA) numerous price transparency provisions are inefficient, says a policy brief from the Pioneer Institute. Hospital executives must make consumer-friendly pricing information a top revenue cycle focus or else...

2 Medicare Alternative Payment Models Demanding Future Focus


Medicare alternative payment models have the ability to make affordable, high quality care a reality. But providers still demand greater levels of care coordination and cleaner streamlining of clinical data to achieve value-based reimbursement...

CMS Rule Addresses Medicare Fraud, Overpayment Compliance


The Centers for Medicare & Medicaid Services (CMS) published a final rule this week focused on improving Medicare compliance, reporting, and self-identified overpayments to ultimately combat Medicare fraud. Under...

The Affordable Care Act’s Effect on Hospital Charity Care


Hospitals provide charity care according to patients’ income levels. But policies and patient criteria often vary depending on the particular hospital. Supporting hospital charity care while maintaining tight margins is a challenge, especially...

Medicare Advantage Value-Based Care Arrangements Up Revenue


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 Says Alternative Payment Models Still Have a Way to Go


Leading healthcare experts are speaking out about whether or not the healthcare industry is making progress in regard to alternative payment models. The healthcare industry is apparently on the right track thus far. Thirty percent of all Medicare...

CMS Reports SNF Payment Incentives May Cut Medicare Spending


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...

AHA: Stark Law Exception Advances Alternative Payment Models


Congress should focus on improving federal fraud and abuse laws, said the American Hospital Association (AHA) to the Senate Finance and House Ways and Means Committee last week. The AHA advocated for an exception to be created under the anti-kickback...

Affordable Care Act Creates Tax-Funded Expenditure Majority


Over 64 percent of healthcare spending is tied to tax-funded expenditures, according to new data from the American Journal of Public Health. This reported number apparently contradicts commonplace perceptions about the cost of healthcare. Researchers...


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