Category: Blog

Affordable Care Act

Affordable Care Act Plans Will Be Able To Offer Wellness Incentives Under CMS Pilot

Insurers can offer premium discounts or other incentives to engage in healthy activities, but questions remain as to whether wellness programs work. Affordable Care Act plans in 10 states will be able to offer wellness programs, as employer-sponsored plans have been doing for years. The Centers for Medicare and Medicaid Services on Monday announced the opportunity for […]
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Prior Authorization

5 Tips for Making Prior Authorizations Less Burdensome

A 2016 study in the Annals of Internal Medicine found that for every hour physicians spend in direct face-to-face clinical time with patients, they spend nearly two additional hours on desk work. According to the American Academy of Family Physicians (AAFP), this administrative burden is one of the primary complaints of its members, and prior authorizations top the list of […]
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Optimizing revenue cycle management

Optimizing Revenue Cycle Management For 2020

With patients seeing higher medical bills than ever and healthcare costs continuing to rise, healthcare organizations need to stay on top of the revenue cycle to ensure they can capture payments and be prepared for changes in 2020. Speaking at the annual meeting of the American Health Information Management Association (AHIMA) in Chicago, Cassi Birnbaum, […]
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Medicaid DSH payments

CMS Finalizes How It Will Cut Medicaid DSH Payments

The Senate passed a continuing resolution that would temporarily stop the implementation of Medicaid DSH payment cuts until Nov. 22, 2019. CMS on Monday finalized a rule that will reduce Medicaid Disproportionate Share Hospital (DSH) payments by $4 billion next year and $8 billion a year until fiscal year 2025. The new final rule will implement Medicaid DSH payment […]
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Claim Denials

Root Causes Linked to Claim Denials

Three revenue cycle tips are provided to reduce denied claims. Claim denials represent millions of dollars in lost and delayed net reimbursement annually. According to the American Medical Association (AMA), cost estimates of inefficient healthcare claims processing, payment, and reconciliation top out at $210 billion per year. Claim denials are so common, they’ve become a fixture […]
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Hospital Revenue Cycle Management

Hospitals Looking Beyond EHR to Improve Revenue Cycle Performance

Over 60 percent of hospitals and health systems are not realizing optimal value from their EHR system, causing the organizations to collaborate with other vendors and outsourcing companies to improve revenue cycle performance. That was a finding from a new Navigant analysis based on an executive survey conducted by Healthcare Financial Management Association (HFMA), which polled 108 […]
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ICD-10-CM Code

New ICD-10-CM Code Rationales

Rationales for ICD-10-CM updates are key to improved medical coding, data reporting, and physician reimbursement. Many of the ICD-10-CM updates for 2020, presented at the ICD-10 Coordination and Maintenance Committee meeting on Sept. 11-12, 2018, provide insight into the purpose of subsequent code changes, which can help you to use the updated code set more […]
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blockchain

How Hospitals, Health Systems Should Approach Blockchain

Pradeep Goel is the CEO of Solve. Care, a healthcare platform aimed at redefining care coordination. Recently, Solve.Care has made partnerships with healthcare organizations to implement it’s healthcare technology in the market. With more than 25 years of healthcare experience, Mr. Goel understands the demands of patients and providers. Below, Mr. Goel discusses how blockchain […]
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coding of vaping

The Coding Conundrum: Vaping-Related Lung Injury

Confusion persists for the coding of vaping. The Centers for Disease Control and Prevention (CDC) is currently investigating vaping-related illnesses that have recently been reported. There are 450 confirmed or suspected cases in 33 states. The first death was reported on Aug. 23, 2019, in Illinois. The concern has escalated to the point that the […]
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