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

Reimbursement News

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...

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...

March 26: Week That Was in Healthcare Fraud and Malpractice


Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility...

AHA Sees Reimbursement as an ICD-10 Implementation Challenge


Reimbursement is a key aspect that will play a big role by ICD-10 implementation as the Oct. 1, 2015 deadline approaches and speculation abounds as to the damaging financial effects an unsuccessful ICD-10 transition could have on healthcare practices...

ICD-10 Preparation Means Actively Protecting Revenue Stream


Provider organizations and physicians continue to prepare for the ICD-10’s unknown revenue impact as the October 1, 2015 looms nearer and providers seek to actively protect revenue stream. Pam Jodock, HIMSS Senior Director of Health Business...

Examining a Holistic Approach to Revenue Cycle Management


As healthcare continues to shift more of its focus on to the customer, a holistic approach to revenue cycle management requires addressing changing consumer behaviors. Providers experiencing an increasing array of reimbursement challenges seek...

Physicians Struggling with Consistency in ICD-10 Transition


ICD-10 implementation involves a complicated code conversion that physicians struggle to comprehend, and the mandated code change raises substantial financial concerns. spoke with Andrew Boyd, Assistant Professor of Biomedical...

Cost Management Effectively Optimizes Revenue Cycle Activity


Effective means for managing revenue cycle activity and optimization continue to evolve amidst the upcoming effects of ICD-10 implementation, the urgent push for mainstream mobile data processing, and a vigorous demand for bundled and capitated...

Electronic Transactions Could Save Healthcare Billions  


As the healthcare industry continuously eliminates paper-based administrative processes and pushes for mainstream electronic transactions, the possible result is essentially tens of billions in savings for the healthcare industry. If six routine...

Physician Compensation Models Need Value-Based Reimbursement


As the healthcare reimbursement shifts from volume to value progresses, many practices are actively reviewing their current compensation plans in connection to accountable care and similar models. Although physician employment was once convolutely...

How Can Practices Improve Claims Management, Reimbursement?


When medical practices cannot maximize revenue and scrub claims because they miss best practice benchmarks, they also miss valuable opportunities to optimize revenue cycle management (RCM). This is one of the findings of a recent NextGen RCM...

Attention to Point of Service Ups Provider Revenue


The piece of the revenue cycle puzzle involving provider revenue poses an innovative challenge for healthcare professionals and requires discussion and further addressing. Point of service is when practices, hospitals, and health systems first...

March 13: Week That Was in Healthcare Fraud and Malpractice


Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice and the Office of Inspector General. The crimes reported below result in multiple millions of dollars...

What Considerations Do Alternative Payment Models Require?


As the direction of various payment models evolve, payers are focusing on a variety of focuses and objectives. Effective physician engagement may require a stronger focus on specialist engagement, especially in preparation for 2018’s transition...

Affordable Care Act Means Lower Reimbursement for Physicians


One year after The Affordable Care Act’s (ACA) implementation, most physicians urge Congress to overturn the legislation after experiencing lower reimbursement, as reported in a recent physician survey. Although 44 percent of surveyed physicians...

Many Denials, Rejections to Follow the ICD-10 Transition?


After profuse speculation and ample delay, the deadline for the healthcare industry ICD-10 transition remains set for Oct. 1, 2015. As popular speculation of especially disastrous results prospers, it is feasible massive denials and rejections...

AMA President Urges Physicians Prepare for ICD-10 Transition


A recent letter from the American Medical Association (AMA) and 99 other physician groups to the Centers for Medicare & Medicaid Services (CMS) expressed collective concern that effective contingency plans require further completion to prevent...

High Critical Access Hospital Reimbursement Costs Medicare


Swing-bed services provided at 90 percent of critical access hospitals (CAHs) could have been avoided by use of neighboring alternative facilities during 2010, reports the Office of Inspector General (OIG). If swing-bed services at CAHs —...

Medicare Advantage Average Payment Cut Hurts Beneficiaries


The Centers for Medicare & Medicaid Services (CMS) proposes to slash Medicare Advantage (MA) and Medicare Part D (MAPD) plan payments next year by an average payment cut of .95 percent, as stated in February’s 2016 Calendar Year (CY)...

What Steps Comprise the Life Cycle of a Medical Claim?


Although reimbursement is a vital aspect within a claim’s life cycle, it is certainly not the only vital piece. It is important to recognize and distinguish each stage from the other within the total life cycle of a medical claim to decrease...


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