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

Reimbursement News

KLAS: Quadax, SSI Group Earn Top Scores for Claims Management

November 16, 2017 - Respondents in a recent KLAS report named Quadax, SSI Group, and ZirMed as the best overall performing claims management vendors because of the high-quality customer service and support provided by the companies. The 296 healthcare organizations interviewed by KLAS almost unanimously agreed that their claims management systems from different vendors generated high-quality claim edits, were...


Articles

Hospital Orgs to Sue CMS Over 340B Medicare Reimbursement Cuts

by

The American Hospital Association (AHA), America’s Essential Hospitals, and the Association of American Medical Colleges (AAMC) recently announced their intentions to pursue litigation against CMS to prevent Medicare reimbursement reductions...

29% of Healthcare Payments Under Alternative Payment Models

by

About 29 percent of healthcare payments in 2016 were paid through an alternative payment model, such as shared savings/risk arrangements, bundled payments, or population-based reimbursements, the Health Care Payment Learning and Action Network...

4 Strategies for Merit-Based Incentive Payment System Success

by

Medicare providers who qualify to participate in MACRA’s Merit-Based Incentive Payment System (MIPS) face up to a 4 percent incentive payment or penalty based on their performance in 2017. Despite MIPS putting revenue at risk, many providers...

382 Hospitals Earn Initial Reconciliation Payments Under CJR Model

by

Out of approximately 800 hospitals required to participate in Medicare’s Comprehensive Joint Replacement (CJR) model, 382 facilities will receive a reconciliation payment based on cost savings and care quality, according to preliminary...

AHA: OIG Hospital Audit Extrapolation Led to Excessive Claim Denials

by

The American Hospital Association (AHA) recently urged CMS to reconsider its extrapolation approach when conducting Office of the Inspector General (OIG) hospital audits because the method leads to excessive repayment requests and claim denials....

Specialists Face 16% MIPS Payment Adjustment Swing Under Proposal

by

Specialists could face up to a 16 percent value-based incentive payment or penalty under MACRA’s Merit-Based Incentive Payment System (MIPS) in 2018 if a proposed rule to include Medicare reimbursement for Part B drugs in the program is...

Cancer Care Costs 60% Higher at Hospitals Vs Independent Orgs

by

Hospital-based cancer care for patients undergoing chemotherapy was 60 percent more expensive compared to the same treatment at community-based oncology practices, according to a recent study by Xcenda and Lucio Gordan, MD, Medical Director in...

Reps Eye Delay for Medicaid Disproportionate Share Hospital Cuts

by

Three House Representatives recently called on their Congressional peers to postpone implementing a rule that would reduce Medicaid Disproportionate Share Hospital (DSH) payments starting on Oct. 1, 2017. The bipartisan letter from Representatives...

EFT Flaws, Paper Enrollment Key Electronic Claims Management Issues

by

Electronic claims management adoption continues to face challenges related to healthcare Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA), a new Workgroup for Electronic Data Interchange (WEDI) white paper explained....

AHA Questions Accuracy of Combined Post-Acute Care Payment System

by

CMS and the Office of the Assistant Secretary for Planning and Evaluation (ASPE) should address fundamental issues with the prototype of a combined Medicare post-acute care payment system, a recent Dobson DaVanzo & Associates report stated....

HHS Offers Special Medicare Reimbursement After Hurricane Irma

by

In the wake of Hurricane Irma, HHS re-opened the National Disaster Medical System (NDMS) Definitive Care Reimbursement Program, a special Medicare reimbursement program that ensures hospitals and other medical facilities receive payment for the...

Driven by Fee-For-Service, Docs Say Up to 30% of Care Unnecessary

by

At least 15 percent to 30 percent of medical care is unnecessary, contributing to low-value resource use and wasteful healthcare spending, stated the majority of physicians surveyed in a recent PLOS ONE study. While the survey of over 2,100...

17% of Practices Pay Fees for Electronic Healthcare Payments

by

Approximately 17 percent of physician practices are forced to pay a fee for receiving electronic healthcare payments from their payers, with fees ranging between 2 and 5 percent of the total reimbursement, a recent MGMA poll of over 900 medical...

Does the Medicare Physician Fee Schedule Undervalue Primary Care?

by

CMS continues to put the revenue of primary care providers at risk by undervaluing codes for primary care and failing to meet the misvalued code target required by law in the proposed 2018 Medicare Physician Fee Schedule update, the American...

63% Capitation Needed to Sustain Primary Care Transformation

by

A new study in Health Affairs found that 63 percent of primary care patients need to be under a capitation payment model to sufficiently fund the practice's transformation to population...

AHA: New Skilled Nursing Facility Payment System Needs Development

by

The American Hospital Association (AHA) recently urged CMS to flesh out a proposal to implement an alternative Medicare reimbursement model for skilled nursing facilities prior to advancing the changes through official rulemaking processes. CMS...

Real-Time Data for Denials Management Aids Practice’s Lagging A/R

by

Without transparency throughout the claim denials management process, healthcare organizations are leaving a significant portion of potential revenue on the table. Limited access to timely claim denial and reimbursement data can prevent providers...

Post-Acute Care Payment Reform Threatens Rural Hospitals

by

A proposed unified Medicare reimbursement for post-acute care services and value-based care payment models, such as accountable care organizations (ACOs) and bundled payments, may propel rural hospital closures as the reforms lower their post-acute...

Medicare Reimbursement Add-On to Boost Palliative Care Revenue

by

A recent study in the Journal of Palliative Medicine showed that providers should be leveraging a supplemental Medicare reimbursement to enhance palliative care in the last seven days of life. CMS pays providers for furnishing routine home care...

Become a member

Complete your profile below to access this resource.

Thanks for subscribing to our newsletter. Please fill out the form below to become a member and gain access to our resources.

Reset your password

Enter your email address to receive a link to reset your password

Continue to site...