The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare Advantage plan (MA, or Part C) and the Medicare prescription drug benefit (Part D) program. In years past, CMS has also issued a “call letter,” not subject to the regulatory process, to provide additional information for plans to use […]
In November 2019, CMS published the 2020 Quality Payment Program Final Rule (the “2020 MIPS Final Rule Changes”). Below is a summary of some of the most notable changes to the Merit-Based Incentive Payment Program (MIPS). For a complete list of changes, please review the 2020 MIPS Final Rule or CMS’ Quality Payment Program Resource […]
Prior authorizations, or prior approvals, are strategies that payers use to control costs and ensure their members only receive medically necessary care. The cost-control process requires providers to acquire advance approval from payers before delivering specific services or items for a patient. Payers are increasingly using prior authorizations to lower their costs and improve care […]
Much of the buzz you hear about artificial intelligence (AI) or machine learning (ML) in healthcare is about its clinical applications, whether assisting doctors with diagnoses or customizing cancer treatment plans. But healthcare is a big industry, and the financial and administrative sides are immense and complex. The reality is AI and ML in healthcare are powerful tools […]
President Trump’s proposed FY 2021 budget includes hospital reimbursement cuts, including more site-neutral payments, as well as a unified post-acute care payment system. President Trump’s proposed budget for the 2021 fiscal year (FY) is stirring up controversy over massive cuts to Medicare and Medicaid spending and proposals to implement work requirements and block grants in Medicaid. But […]
Case study proves the need for physicians to be members of the CDI team. Having a strong denials management team is critical for facilities. If providers do not leverage proper resources to generate strong appeal letters, the third-party payers will uphold their decisions to remove or change diagnosis or procedure codes. This usually will lead […]
Revenue cycle management encompasses everything related to the order-to-cash process. For success in revenue cycle management, constant and vigilant oversight of the key processes is needed. With that oversight, continuous process improvement can help you maximize profitability. Here are some areas to focus on to improve receivable collections. Check Your Front End No matter how […]
The healthcare industry is unlike any other. In other businesses, you provide a product or service and the customer puts cash in your hand (more or less). However, the healthcare industry is very different. With multiple providers, claims to manage and reimbursements to deal with, getting money in the door in a timely manner can […]
Artificial intelligence (AI) is a concept that has moved very quickly from the realm of science fiction into real and practical utility in a number of different industries—including healthcare. One of the most effective applications for AI-powered tools is in the field of revenue cycle management. Sophisticated AI technologies can sift through vast amounts of […]
Emergency departments are under intense pressure to do more with less, and drilling down into clinical and operational data can provide opportunities to offset decreasing revenues Many emergency providers are starting to find themselves caught within a perfect storm, with pressure from reduced reimbursements building steadily across all payer types. Medicare payments for emergency care have effectively […]