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

Reimbursement News

3 Strategies to Improve Healthcare Supply Chain Management


The evolution and progression of supply chain and reimbursement tactics and procedures within the healthcare industry serves as a keen focal point requiring acute attention to detail if success is to be met. The following is a compilation of...

How to Rescue Revenue Cycle with Medicare Appeals Pending


The rehabilitation needs of Medicare beneficiaries within the state of California may be in jeopardy. Payment for hundreds of thousands of claims for services is being denied. Most of these denials are reportedly invalid, confirms past appeal...

HHS Urged to Resolve Pending Medicare Appeals in Filed Suit


Casa Colina Hospital and Centers for Healthcare recently filed suit to require timely Medicare patient care appeals mandated under federal law.  The Medicare program is denying payment for hundreds of thousands of claims for services....

Are the Cheapest Provider-Owned Health Plans More Expensive?


The demise of the fee-for-service model may be unsuccessful in producing the most economically efficient health plans, confirms a new study from HealthPocket. Demonstrating significant findings that are simply “contrary to expectations,”...

Unreliable Health Plan Provider Directories Burden Providers


Under the establishment of the Affordable Care Act (ACA), millions of people have enrolled in new health insurance plans via the health insurance marketplace. When signing up for these new plans, consumers rely on information provided to them...

Is the ACA Working as Intended to Improve Healthcare Access?


Is the Affordable Care Act (ACA) living up to its full potential or is it more a matter of all healthcare hands on deck? In past interviews with, healthcare experts and leaders from both athenahealth and the Robert...

Value-Based Payment Preparation Requires Cost Measurement


Value-based payments present numerous challenges to healthcare providers. Healthcare finance departments may have a bit of catching up to do. Following an announcement from the Centers for Medicare & Medicaid Services regarding an actively...

How to Manage ACO Risk with Value-Based Purchasing Programs


The game of Risk is more than just a generally entertaining board game about world supremacy. It is also a critical game healthcare providers, payers, and hospital executives play daily regarding their own revenue cycle management objectives....

Twelve Things to Know Now About Value-Based Reimbursement


The healthcare industry continues to move away from fee-for-service and advance further into the realm of value-based care. But at what pace? Perhaps rather quickly. Some healthcare experts and leaders confirm an alleged hastening pace means...

Rural Hospitals Address Medicare Reimbursement Cut Concerns


Rural hospitals may be losing the Medicare reimbursement battle. Legislative pushes are being considered by Congress to alleviate the possible financial death of the rural hospital as reimbursement cuts continue to weaken the financial backbone...

EHRs Advance Medicaid Reimbursement and Stabilize Insurance


The meaty 1,024 pages of the Affordable Care Act (ACA) call for the vast expansion of healthcare coverage, the active promotion of decreased healthcare costs, and enhanced quality care. In the midst of ACA expansion efforts, Medicare and Medicaid...

Next Generation Analytics Demand Actionable Results


The value-based reimbursement movement has a leader. That leader is the Centers for Medicare & Medicaid Services (CMS). Indeed, there has been a great deal of hustle and bustle regarding many recent initiatives from CMS,...

ICD-10 Implementation: Five More Facts to Know Now


Last week, presented the top five facts to know now about ICD-10 implementation, as reported by the Centers for Medicare & Medicaid Services (CMS). Here are five (more) facts to know now, as announced by CMS. Knowledge...

Integrated Community Oncology Practices Need Cost Efficiency


Integrated community oncology practices represent a core foundation of cancer care by promoting a rewarding patient experience and helping cancer patients successfully battle complex social and health issues. Unfortunately, financial obstacles...

Physician-Led ACOs Need Opportunities to Thrive


Many of the HIMSS15 educational sessions this week in Chicago offered valuable insight into the financial future of the healthcare industry. Farzad Mostashari, MD, ScM, Aledade Inc. Founder and CEO and former National Coordinator...

Value-Based Reimbursement: Humana CEO’s Payer Perspective


In a Tuesday morning keynote speech at the Healthcare Information and Management Systems Society’s (HIMSS’) annual HIMSS15 conference and exhibition conducted this week in Chicago, Bruce D. Broussard, CEO and President of Humana,...

CMS’ Open Payments Advance Revenue Cycle Transparency


Physicians and teaching hospitals across the healthcare spectrum will be buried in a numbers game come April 6, 2015 when The Centers for Medicare & Medicaid Services’ (CMS’) period of payment review for physicians begins. Open...

New WEDI Focus on Bundled Payments, Value-Based Initiatives


The Workgroup for Electronic Data Interchange (WEDI) recently announced its Payment Models Workgroup is forming a new project team committee – the Bundled Payments Taskforce – to more closely examine bundled payments and various value-based...

Does the Sustainable Growth Rate Mean Smarter Reimbursement?


Last week, the House of Representatives passed legislation that permanently repealed the Sustainable Growth Rate (SGR) formula and established an original reimbursement plan with fundamentally implemented value-based care incentives. The Senate...

Quantify Denial Rates for Smooth Revenue Cycle Management


A hospital or medical practice’s ability to swiftly and economically process claims and quantify denial rates is critical to ensure smooth revenue cycle management and medical reimbursement. The ability to accurately predict reimbursement...


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