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

Reimbursement News

Does the Medicare Physician Fee Schedule Undervalue Primary Care?


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...

63% Capitation Needed to Sustain Primary Care Transformation


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...

AHA: New Skilled Nursing Facility Payment System Needs Development


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...

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


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...

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...

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...

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...

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...

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...

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...

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...

$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...

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...

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,...

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...

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...

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...

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...

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...

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...

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