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

Policy & Regulation News

CMS Tackles Medicare Spending, Medicaid Financial Incentives


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...

Revenue Cycle Management a Post-ICD-10 Implementation Focus


Healthcare organizations are focused on strengthening revenue cycle management processes in a post-ICD-10 environment, according to Porter Research and Navicure’s national ICD-10-centered survey. As the concluding chapter of a...

CMS Makes Revisions to Medicare Prospective Payment System


The Centers for Medicare and Medicaid Services (CMS) is making changes to the Medicare hospital inpatient prospective payment systems (IPPS). CMS says it is modifying 2016’s IPPS Pricer to reflect a new payment calculation adjustment...

55 Hospitals File Two-Midnight Rule Lawsuit Against HHS


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...

CMS’s Medicare Drug Spending Dashboard Notes Spending Spike


The Centers for Medicare & Medicaid Services (CMS) has released a Medicare Drug Spending dashboard to address prescription drugs’ affordability. CMS aims to make drug spending trends more transparent for healthcare providers. CMS...

Why Chronic Illness is Threatening the Healthcare Industry


1 in 4 primary care physicians feel dangerously ill-equipped to successfully handle and coordinate care for some of their most challenging patients, such as those with chronic conditions, severe mental illness, and those in need of long-term...

AMA, CMS Lead Discussion on Evolving Healthcare Market Today


The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) are pairing up to lead a discussion today about the ongoing state of the evolving healthcare market. The discussion will be held at 5PM (PT) at...

CMS, HHS Get Social with $157M in Medicare, Medicaid Funding


The Department of Health and Human Services (HHS) has revealed a new 5-year $157 million funding opportunity this week to help advance the overall quality and affordability of Medicare and Medicaid. The health-related social needs of Medicare...

CMS Tackles Value-Based Purchasing Pilot Program Questions


Competition across the nation for value-based payment incentives is underway with the start of a new year. Nine states, each representing a different geographic region, have implemented the home health value based purchasing pilot program...

CMS Says Information Technology Builds Healthcare Delivery


The Centers for Medicare & Medicaid Services (CMS) is beginning the New Year with a happy and healthy resolution tied to the significance of health information technology (IT). CMS declared in an official blog post last Wednesday that it...

Why the Value-Based Care Journey Begins with Assessment


How to find value in the value-based care reimbursement movement is one goal the healthcare industry will likely be striving for in 2016. As Medicare, Medicaid, and commercial health plans continue to press hospitals and physicians to implement...

2015: Year That Was in Healthcare Fraud and Malpractice


Here is a general roundup of the past year’s developments in healthcare fraud and malpractice, as reported by the Department of Justice and the Office of Inspector General (OIG). The crimes reported below result in multiple millions of...

How a Palliative Care Focus Eases Healthcare’s Cost Burdens


As physicians across the country mull over their New Year’s resolutions this week, the overarching desire for a healthy revenue cycle will likely be a common theme. Physicians often struggled with how to keep money flowing as easily as New...

How Advanced Care Discussions Impact Provider Payment Focus


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)...

CMS’s Quality Measurement Development Plan Supports MIPS, APM


2016 may be an especially good year for healthcare providers when it comes to matters of revenue cycle management. The Centers for Medicare & Medicaid Services (CMS) recently posted a 63-page Measure Development Plan, a strategic framework...

How CMS’s Proposed IMPACT Act Impacts Healthcare Providers


Every patient who steps foot into a hospital – from the college quarterback with a broken collarbone to the octogenarian diagnosed with numerous comorbidities – may soon require a discharge plan, according to a new proposed rule from...

10 Standout Revenue Cycle Management Quotes of 2015


Actions speak louder than words. But sometimes, the pen is indeed mightier than the sword.  Here are 10 selected quotes (presented in no particular order), exclusive to from the last year that may make you stop...

Congress Passes 2-Year Cadillac Tax Delay, Repeal Possible


Congress has passed a two-year delay of the Cadillac Tax – a 40% non-deductible tax on the cost of employer-sponsored health coverage that surpasses specific benefit thresholds, part of the Omnibus spending package. Congress passed the...

CMS Releases Fee-for-Service Data for Home Health Agencies


The Centers for Medicare & Medicaid Services (CMS) is striving once again to make the healthcare industry more  transparent, affordable, and accountable with the dissemination of free-flowing information. CMS has released...

Why HOPD Medicare Expenditures Need Equalized Payment Rates


Medicare expenditures for hospital outpatient departments (HOPD) services are apparently on the rise, especially in recent years. A new report to Congressional requesters from the United States Government Accountability Office (GAO) examines...


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