CMS wants to identify bad actors -– even if they are or have been affiliated with a legitimate provider. On Sept. 5, the Centers for Medicare & Medicaid Services (CMS) issued a new final rule. There was not really a proposed rule to which comments and suggestions could be made; there were Federal Register entries […]
Hospitals assuming downside financial risk under value-based care models is the key to lowering healthcare costs and improving quality, CMS believes. CMS Administrator Seema Verma urged hospitals on Tuesday to accept new value-based care models and price transparency requirements or face greater administrative burden, less competition, and lower reimbursement rates under Medicare for All. “Our choices are […]
Improving revenue cycle performance has become more challenging amid today’s healthcare payment trends and patient financial expectations. To gauge efforts at hospitals and health systems, Becker’s Hospital Review asked healthcare leaders to share changes their organizations have made to improve revenue cycle performance this year. Read their responses below, presented alphabetically. Venkat Bhamidipati Executive vice president and […]
HIV/AIDS payments, in particular, are under the microscope. The new Patient-Driven Payment Model, or PDPM, makes radical changes to the Medicare payment model for nursing homes. One of the largest changes is the reimbursement rate for services provided to HIV and AIDS patients. In 2016, there were 15,807 deaths among people with diagnosed HIV in […]
In the crowded healthcare market, smart healthcare leaders must find patient satisfaction advantages everywhere they can. When it comes to patient satisfaction, providing excellent clinical care is a no-brainer. But in a crowded and competitive healthcare market, smart healthcare leaders know that they need an edge everywhere, including an efficient revenue cycle. That’s the case […]
Final rules will impact nearly every type of healthcare provider. The Centers for Medicare & Medicaid Services (CMS) presented us with quite a number of Medicare payment rules in the last week or so, referencing almost every type of provider in the program. The final rules included the Fiscal Year (FY) 2020 Medicare Hospital Inpatient […]
Medical necessity denials continue to be a pain point for revenue cycle leaders, so much so that HBI members reported medical necessity as one of the top three root causes in 2016, 2017, and 2018. While denials and appeals are typically housed within the revenue cycle, there are many other teams—including clinical staff, utilization review, […]
Hospitals and health systems are exploring ways to revenue cycle transformation processes to offset financial pressures. However, shifting to a new business model for revenue cycle management can be challenging. The hospital revenue cycle has become increasingly complex in recent years for several reasons, including the shift away from fee-for-service medicine, the adoption of advanced […]
For many healthcare providers, claim denials are a frustrating cost of doing business. Each year, around 5-10% of medical billing claims are rejected (possibly more). With each claim costing around $25 to rework, providers lose billions in eroded revenue and productivity. Any revenue leakage is bad enough, but the shift towards value-based care means tighter revenue cycle management […]
The U.S. healthcare industry has a $1 trillion opportunity to cut costs and reduce waste, according to a 2015 Harvard Business Review analysis. While there are various areas waste accumulates, costly data reconciliation is a prominent problem for hospitals and health systems. Change Healthcare defines data reconciliation as “the process of compiling information across companies […]










