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

Latest RCM News News

GAO Announces New Physician-Payment Model Advisory Committee


The Government Accountability Office (GAO) has announced 11 new initial committee members appointed to the Physician-Focused Payment Model Technical Advisory Committee. Selected members, who will serve intentionally zigzagged terms...

HHS Announces $685M Awards in Patient-Centered Clinician Aid


The Department of Health and Human Services (HHS) is on a mission to improve the quality of healthcare, advance patients’ information accessibility, and decrease expenses across the industry. According to today’s announcement from...

Summary of CMS’s Top 5 Proposed Payment Rules, Revisions


The Centers for Medicare & Medicaid Services (CMS) has continuously released a steady stream of payment policies and physician fee schedules. As reported in a summary of top 6 previously proposed payment rules and...

No Medicare Claim Denials After ICD-10 Transition, Says CMS


ICD-10 implementation is now a horse of a different color. The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are seeing eye-to-eye on matters of ICD-10 and claims denial. CMS has outlined 4...

CMS Announces HPID Final Rule Public Commentary Period


The Department of Health and Human Services (HHS) released a Request for Information (RFI) earlier this month on the Health Plan Identifier (HPID). HPID – a standard identifier for health plans – is required to be adopted under the...

Cigna Rejects Anthem’s ‘Woefully Skewed’ $53.8B Proposal


The largest ever proposed health insurance merger perhaps falls short. Anthem, Inc announced its submission this week of a highly conditional, non-binding $53.8 billion proposal, including debt, to acquire Cigna Corporation for $184 per share...

AMA Inaugurates Stack, Youngest President in 160 Year History


Steven J. Stack, MD, has been sworn in as the youngest president of the American Medical Association (AMA) within the past 160 years. Stack is the 170th president of the AMA, the nation’s largest physician organization. "I am...

CMS: Successful April Medicare FFS ICD-10 End-to-End Testing


According to today's announcement from the Centers for Medicare & Medicaid Services (CMS), ICD-10 implementation success is here. Between Monday, April 27 and Friday, May 1, Medicare Fee-For-Service (FFS) healthcare providers, clearinghouses,...

New House Bill Requires ICD-10 Transition Period Testing


The House of Representatives has introduced a new bill, H.R. 2247, requesting a mandatory ICD-10 transition period following the October 1, 2015 ICD-10 implementation date. This bill – the Increasing Clarity for Doctors by Transitioning...

CMS Promotes ICD-10 Readiness with More End-to-End Testing


There are 142 days left until the International Classification of Diseases – ICD-10 – compliance. What’s next? More Medicare end-to-end testing efforts, says The Centers for Medicare & Medicaid Services (CMS). CMS has announced...

AHA Announces New President and CEO, Rick Pollack


Rick Pollack will be the next President and Chief Executive Officer of the American Hospital Association (AHA), announces AHA’s Board of Trustees. This September, Pollack will formally replace Richard J. Umbdenstock. Umbdenstock is...

Bipartisan House Repeals Medicare SGR Before Senate Vote


There are possible new improvements to the Medicare Sustainable Growth Rate (SGR) payment system today as the bipartisan House of Representatives overwhelmingly passed the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2). This legislation...

Hospital Claims $173,000 in Medicare Overpayments


Hospital did not fully comply with Medicare requirements for billing inpatient and outpatient services. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results of its audit on Utah Valley Regional...

Medicaid Expansion in Nebraska and Kansas


With 29 states and DC having already opted to expand their Medicaid coverage, other states are aiming to join the trend. The decision to expand Medicaid continues to be a legal struggle for many states. The decision could substantially...

Pennsylvania Plans for Medicaid Expansion


The Medicaid expansion is 100 percent federally funded for the years 2014 through 2016. On February 9, 2015, Governor of Pennsylvania, Tom Wolf announced that the State would be transitioning to a Medicaid expansion plan. This plan will replace...

Wyoming Rejects Medicaid Expansion with 19-11 Vote


Following the negative feedback on the Budget, the bill was rejected with a 19-11 vote and a parallel Medicaid expansion bill was pulled. According to an article by Ruffin Prevost on Reuters, on February 6, 2015, the Wyoming Senate rejected a...

Groups Question Changes to Medicare Shared Savings Program


118 out of 220 participating Medicare Shared Savings Program ACOs generated savings through reduced costs, but only 58 of these ACOs managed to meet the shared savings threshold. Seventeen medical organizations which includes the American College...

AHA Reacts to Proposed Rule for Medicare Shared Savings Program


CMS’s proposed changes to the Medicare Shared Savings Program would save approximately $280 million more than the median net savings in federal funds from 2016 through 2018. The Medicare Shared Savings Program (MSSP) seeks to save money...

Medicare Overpays Hospital $414,000 for Incorrect Medical Billing


The Hospital did not fully comply with Medicare requirements resulting in approximately $414,000 in overpayments for incorrect medical billing. The Department of Health and Human Service (HHS) Office of Inspector General (OIG) released the results...

Hospitals Oppose Further Medicare and Medicaid Cuts


The AHA and other hospital groups wrote a letter to Congress, encouraging them to avoid  Medicare and Medicaid cuts following the repeal of the SGR. The Medicare Sustainable Growth Rate (SGR) has long been a thorn in healthcare’s...


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