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

Latest RCM News News

Court to Reconsider Timeline for Medicare Appeals Backlog End

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The DC appeals court recently revoked the court-ordered elimination timeline for the current $6.6 billion Medicare appeals backlog, arguing that the previous court was in error of the law by requiring HHS to do away with the backlog despite the...

CMS May Cancel Upcoming Cardiac, Ortho Bundled Payment Models

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UPDATE: CMS released the complete proposed rule, which would cancel the Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model. The proposed rule would also decrease the number of mandatory geographic regions in the Comprehensive...

Quality Payment Program, MIPS Top 2017 Regulatory Burden List

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Medicare’s new value-based reimbursement program has topped the list of most burdensome regulations for healthcare providers, according to a new MGMA survey. About 82 percent of leaders from 750 group practices viewed MACRA’s Quality...

CMS Ups Medicare Reimbursement for Inpatient Admissions $2.4B

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Medicare reimbursement updates and other payment policy changes finalized in a new rule from CMS will boost inpatient hospital payments by $2.4 billion in 2018 and decrease long-term care hospital payments by $110 million. “This final rule...

Skilled Nursing Facilities See $370M Medicare Reimbursement Bump

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Skilled nursing facilities are slated to receive a 1 percent increase in Medicare reimbursement in 2018, representing $370 million more dollars in healthcare payments, CMS recently announced in a final rule. While CMS finalized Medicare reimbursement...

CMS Details $43B Drop in Medicaid Uncompensated Care Support

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In a recently proposed rule, CMS outlined a methodology for reducing Medicaid support for hospitals incurring significant uncompensated care costs starting in 2018. The rule would implement reductions of $1 billion per year in Medicaid Disproportionate...

Healthcare Revenue Cycle Software Market to Grow at 4.5% CAGR

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The healthcare revenue cycle management software market is slated to grow at a modest compound growth rate (CAGR) of 4.5 percent between 2017 and 2021, stated a recent Research and Markets report. “The latest trend gaining momentum in the...

CMS Considers Behavioral Health Alternative Payment Model

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CMS recently announced its intention to develop an alternative payment model targeting behavioral health services. The federal agency is seeking stakeholder feedback on model development in a public meeting on Sept. 8, 2017, in Baltimore. The...

AMA Backs CMS Diabetes, Legacy Value-Based Purchasing Changes

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The American Medical Association (AMA) recently commended CMS for several recommendations outlined in the recently proposed 2018 Physician Fee Schedule rule. The industry group particularly welcomed a potential Medicare Diabetes Prevention Program...

Beth Israel, Lahey Health Ink Final Healthcare Merger Agreement

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Boston-based Beth Israel Deaconess health system and Lahey Health recently finalized a healthcare merger agreement after about seven months of negotiations. Despite several failed attempts at a healthcare merger in the past, the two health systems...

Hospital Orgs Oppose Site-Neutral Medicare Reimbursement Cuts

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Several hospital groups recently spoke out against proposed 2018 Medicare reimbursement updates that would reduce site-neutral payments to off-campus provider-based departments from 50 percent of the outpatient rate to 25 percent. CMS recently...

Hospitals, ASCs, 340B Drugs Face Medicare Reimbursement Changes

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CMS recently proposed a rule that would update Medicare reimbursement rates for hospitals and ambulatory surgical centers as well as change some prescription drug rates to 340B hospitals. Hospitals would see a 2 percent Medicare reimbursement...

Healthcare Costs Up 47.2% Despite Little Change in Utilization

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Healthcare costs increased 47.2 percent from $246 per individual per month in 1996 and 1997 to $362 per individual per month in 2011 and 2012 despite healthcare utilization and the number of individuals seeking care remaining relatively unchanged...

LA Hospital Pays $42M to Settle Healthcare Fraud, Kickback Case

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Los Angeles-based Pacific Alliance Medical Center recently agreed to pay $42 million in order to settle an ongoing healthcare fraud case involving improper financial relationships between the acute care hospital and referring physicians. According...

Healthcare Prices, Spending, Employment Decline in Early 2017

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Recent research from the Altarum Institute showed that healthcare prices, spending, and employment are all trending downward after a three-year period of healthcare spending acceleration. Healthcare employment growth declined by 10,000 per month...

Medicare Cardiac, Ortho Bundled Payments Delayed Until 2018

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CMS recently delayed the launch date of three mandatory Medicare cardiac and orthopedic bundled payment models and the Cardiac Rehabilitation Incentive Payment program from May 20, 2017, to Jan. 1, 2018. The final ruling from the federal agency...

Third MI Provider Convicted in $17.1M Healthcare Fraud Case

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Healthcare fraud prevention and prosecution will continue to be a major area of focus for the Department of Justice (DoJ), Acting Assistant Attorney General Kenneth A. Blanco recently told the American Bar Association. With healthcare fraud draining...

CMS Opens Comprehensive Primary Care Plus Apps in 4 Regions

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CMS recently announced that the second round of the Comprehensive Primary Care Plus (CPC+) alternative payment model will launch in four regions in 2018. The four regions are Louisiana, Nebraska, North Dakota, and the greater Buffalo area of...

10 Orgs Call for Medicare Advantage APMs to Qualify for MACRA

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A coalition of ten healthcare industry groups recently urged HHS Secretary Tom Price to weigh risk-based Medicare Advantage alternative payment models the same as Advanced Alternative Payment Models under MACRA. Qualifying participants in MACRA’s...

Execs Say Value-Based Purchasing to Hit Tipping Point by 2020

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Over one-half (55 percent) of healthcare executives surveyed after the recent presidential election stated that the industry should reach the value-based purchasing tipping point before 2020, a recent Lazard report revealed. The survey of 203...

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