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

Reimbursement News

Medicare Advantage Plans Overturn 75% of Their Own Claim Denials


A new report from the HHS Office of the Inspector General (OIG) reveals “widespread and persistent problems” related to prior authorization and claim denials in Medicare Advantage. Using Medicare Advantage data on denials,...

Clinical Documentation Improvement Solutions Up Provider Revenue


Provider organizations are seeing financial improvements after implementing clinical documentation improvement (CDI) solutions, a recent KLAS survey shows. Revenue improved for about 53 percent of healthcare executives, medical records...

AHA Decries Proposed Expansion of Outpatient Site-Neutral Payments


CMS should withdraw new proposals to expand site-neutral payments to hospital outpatient clinic visits and services from expanded clinical families delivered at off-campus provider-based departments (PBDs), the American Hospital...

Providers Oppose Collapsing Medicare Reimbursement for E/M Visits


Providers are calling on CMS to not finalize a proposal to collapse Medicare reimbursement for evaluation and management (E/M) visits into a single, blended payment rate for E/M Levels 2 through 5 visits. In a recently proposed rule for...

RCCH Uses Predictive Analytics to Boost Claim Denials Management


Predictive analytics are key to implementing an effective and efficient claim denials management strategy that tackles the right denials at the right time, according to the Vice President of Revenue Cycle at Tennessee’s RCCH...

AMA Adds Connected Health CPT Codes, Pushes for Medicare Payment


The American Medical Association (AMA) updated the Current Procedural Terminology (CPT) code set in 2019 to include new codes for connected health services in an effort to encourage CMS to pay for the services. The 2019 CPT code set...

Paying LTCHs Like Skilled Nursing Would Save $4.6B, Analysis Finds


Eliminating the concept of long-term care hospitals (LTCHs) would save Medicare $4.6 billion per year without harming patient outcomes, a new National Bureau of Economic Research working paper found. Medicare savings would stem from the...

Artificial Intelligence Ensures Payer, Provider Pay Covers Costs


Artificial intelligence (AI) in healthcare is influencing the next generation of radiology tools and helping to expand access to care in underserved or developing areas. The technology is supporting clinical advancements, but a...

Providers Praise E/M Documentation Changes, Oppose Payment Plans


Physicians and other healthcare professionals recently welcomed proposed evaluation and management (E/M) documentation changes from CMS that would reduce administrative burden and streamline Medicare billing. Specifically, the American...

When Claims Reimbursement Doesn’t Cover Healthcare Innovation


Implementing healthcare innovations that improve care quality is key to boosting patient experience and care quality, but what happens when claims reimbursement doesn’t cover the use of the latest and greatest services? This is the...

HHS to Clear Medicare Appeals Backlog by 2022, Court Docs Show


HHS is making significant progress with eliminating the growing Medicare appeals backlog, according to recent court documents. The federal department projects Medicare to clear the backlog by the 2022 fiscal year. A 70 percent increase in...

Medicaid Could Save $4.8B Through Electronic Claims Management


State Medicaid programs are significantly lagging with the adoption of fully electronic claim submissions, claim reimbursements, prior authorizations, and other claims management processes, according to a new Council for Affordable Quality...

Post-Acute Care Providers Worry About Patient-Driven Payment Model


Leading post-acute care associations are expressing concerns with the recently finalized Patient-Driven Payment Model (PDPM), which will tie skilled nursing facility (SNF) reimbursement to value, rather than therapy volume. CMS issued the...

CAQH Stresses the Importance of Prior Authorization Automation


CAQH’s Committee on Operating Rules for Information Exchange (CORE) is urging a group of industry leaders to encourage prior authorization automation as part of their efforts to improve the entire prior authorization process. The...

Hospital Groups Decry Proposed Outpatient Reimbursement Cuts


Hospitals groups are voicing their concerns with potential site-neutral payments and other outpatient reimbursement reductions proposed in a new rule from CMS. CMS released its proposed CY 2019 Outpatient Prospective Payment System (OPPS)...

340B Hospitals Provided Similar Charity, More Uncompensated Care


The debate over whether 340B hospitals truly use discounted prescription drug rates to improve care for vulnerable, low-income patients goes on with a new Government Accountability Office (GAO) report. GAO found that the median amount of...

Court Rejects AHA’s Attempt to Block 340B Hospital Payment Cuts


A federal appellate court recently tossed the American Hospital Association’s (AHA) lawsuit against HHS, which attempted to block $1.6 billion in 340B hospital payment cuts. Three judges on the US Court of Appeals for the District...

CMS Misses Chance to Move Physician Pay, QPP to Value, AMGA Says


CMS recently proposed several changes to Medicare physician payments and MACRA’s Quality Payment Program to reduce medical billing and administrative burden. But initial reactions from medical group associations have not been...

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