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

Reimbursement News

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

August 18, 2017 - 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 from recouping revenue that is rightfully theirs. As a result, providers are passing up an opportunity to recover reimbursement for up to 63 percent...


Post-Acute Care Payment Reform Threatens Rural Hospitals


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


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...

Medicaid Reimbursement Woes Key Concern for Healthcare CEOs


Approximately 85 percent of healthcare executives identified shrinking Medicaid reimbursement rates and funding as a top concern in 2017, according to a new Deloitte survey. Deloitte surveyed 20 CEOs from health systems that collectively produced...

Skilled Nursing Facilities See $370M Medicare Reimbursement Bump


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...

Do Oncology Bundled Payments Promote Low-Value Drug Use?


Oncology bundled payments are not the answer to lowering prescription drug costs for cancer care delivery, the American Society of Clinical Oncology recently contended. In a position statement on addressing the affordability of cancer drugs,...

3 Challenges Providers Face with Healthcare Bundled Payments


Healthcare bundled payments are becoming one of the most popular alternative payment models available to providers. Providers are drawn to the episode-based structure’s ability to decrease healthcare costs while maintaining or improving...

Provider Profitability Drops Under Biosimilar Use Reimbursement


Biosimilar use could be the key to lowering healthcare costs associated with biologic treatments, but provider profitability may suffer by as much as $100 million across care settings if providers continue to administer the low-cost alternative,...

$262B of Total Hospital Charges in 2016 Initially Claim Denials


Approximately 9 percent of hospital charges in 2016 were initially claim denials, according to a new Change Healthcare study. As a result, $262 billion out of $3 trillion in claims submitted last year was denied. The analysis of over 3.3 billion...

Limited Healthcare Payment Incentives Challenge Care Management


Misaligned healthcare payment incentives topped the list of challenges providers and payers faced when implementing effective care management programs under Medicare Advantage plans with capitated payments, a recent Robert Graham Center for Policy...

MedPAC Eyes Merit-Based Incentive Payment System Redesign


The Medicare Payment Advisory Commission (MedPAC) recently advised Congress to redesign MACRA’s newly-launched Merit-Based Incentive Payment System (MIPS) by eliminating MIPS measures, replacing them with population health measures, and...

Provider Collaboratives Combat Healthcare Merger Pressures


Value-based reimbursement continues to drive healthcare merger and acquisitions activities. But hospitals and health systems can remain independent and achieve healthcare cost reduction and value-based reimbursement goals by joining a provider...

86% of Providers Saw Prior Authorization Requirements Increase


Approximately 86 percent of medical practice leaders reported that prior authorization requirements have increased over the past year, a recent MGMA survey of over 1,000 leaders found. Only 3 percent stated that prior authorization requirements...

Incorporating Population Health in Next Gen of Bundled Payments


The next generation of bundled payments should focus on population health management, researchers recently argued in a Journal of the American Medical Association report. Bundled payment models can align with population health management by extending...

2016 Medicaid, Medicare Improper Payments Over Regulatory Cap


A recent Office of the Inspector General (OIG) report revealed that the rates of Medicaid and Medicare improper payments in 2016 exceeded the legislative threshold of less than 10 percent. The improper payment rate for Medicare fee-for-service...

AHA Urges Rural, Post-Acute Care Medicare Reimbursement Reform


In a Congressional hearing on the current status of Medicare reimbursement systems, the American Hospital Association (AHA) urged lawmakers to focus on rural hospital and post-acute care payments. MACRA extended a number of key Medicare reimbursement...

Will Behavioral Economics Improve Alternative Payment Models?


Alternative payment models may need to account for the behavioral economics behind provider prescribing habits to effectively reduce healthcare costs from expensive medications and treatments, a recent American Journal of Managed Care study stated....

Medicare Appeals Backlog Delays Decision Process By 4.5 Years


Hospitals waited an average of 1,663.3 days, or a little over 4.5 years, to conclude the Medicare reimbursement audit and appeals process because of the extensive Medicare appeals backlog, a recent Journal of Hospital Medicine study uncovered....

3 Best Practices for Hospital Claim Denials Management


Healthcare cost control continued to top hospital priority lists in 2017. But hospital leaders may be leaving millions of dollars on the table because of inefficient claim denials management processes. Claim denial rates ranged between 0.54 percent...

Creating Alternative Payment Models to Support Health Centers


Healthcare stakeholders and lawmakers should encourage community health centers to engage in alternative payment models to financially incentivize providers to improve safety-net care, a recent Journal of the American Medical Association report...


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