Category: Revenue Cycle Management

13-recent-cms-actions

13 recent CMS actions

  CMS recently released new data on hospital changes of ownership, a health equity plan and said it would end a legal battle with Texas over Medicaid. Becker’s has reported on the following 13 CMS moves since April 8. Finance No hospitals received price transparency notices in April, CMS says CMS issued no additional warning […]
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bridge-the-gaps-between-payer-and-provider-by-automating-your-revenue-cycle

Bridge the gaps between payer and provider by automating your revenue cycle

The health care industry is rapidly evolving. COVID-19 has uncovered a litany of flaws in health care systems, leading to massive changes in the way patients, providers, and payers communicate and operate. One of the highest impact changes in the industry is the widespread shift from a traditional fee-for-service reimbursement system to value-based care. Instead […]
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cms-considers-use-covid-19-claims-fy-2023-rate-setting

CMS considers use of covid-19 claims for fy 2023 rate setting

CMS released the fiscal year (FY) 2023 inpatient prospective payment system proposed rule with proposals for new calculations for FY 2023 rate setting. Although CMS is proposing to use FY 2021 data for FY 2023 Medicare Severity Diagnosis-Related Groups (MS-DRG) rate setting, the agency wants a modified methodology to account for the historical and potential […]
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cms-hhs-finalize-2023-notice-of-benefits-payment-parameters

CMS, HHS Finalize 2023 Notice of Benefits, Payment Parameters

  CMS and the Department of Health and Human Services (HHS) released the 2023 Notice of Benefits and Payment Parameters Final Rule, which includes standardized plan options, changes to network adequacy reviews, refinements to the Affordable Care Act’s essential health benefits nondiscrimination policy, and other changes. “The recent Open Enrollment Period demonstrated the demand for […]
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revenue-cycle-leaders-experience-price-transparency-rule-burden

Revenue Cycle Leaders Experience Price Transparency Rule Burden

Revenue cycle leaders noted that the confusing regulations included in the CMS price transparency rule make it difficult for their organizations to achieve compliance. The majority of revenue cycle leaders were dissatisfied with aspects of the CMS hospital price transparency rule and expressed doubt about the regulation’s efficacy, according to a KLAS report RevCycleIntelligence received […]
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key-advantages-of-medicare-advantage-plans-versus-ffs-medicare

Key Advantages of Medicare Advantage Plans Versus FFS Medicare

Medicare Advantage plans draw a more diverse beneficiary population and can result in lower healthcare spending for low-income beneficiaries. Medicare Advantage plans may provide better access to care and lower healthcare spending for enrollees, compared to fee-for-service Medicare, according to a study from ATI Advisory conducted on behalf of Better Medicare Alliance (BMA). “Medicare Advantage […]
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what-s-driving-the-transition-to-value-based-care

What’s driving the transition to value-based care?

The COVID-19 pandemic has taught us it’s possible for the health care system to transform care delivery—and quickly. We saw vaccines come to market in record time, heightened cross-industry collaboration to track vaccine statuses, and virtual care use surge. Similarly, the pandemic demonstrated that value-based care delivery models, where payment is based on outcomes versus […]
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hhs-distributes-1.75b-in-phase-4-covid-19-provider-relief-funds

HHS Distributes $1.75B in Phase 4 COVID-19 Provider Relief Funds

  Around 3,600 healthcare providers that have experienced pandemic-related revenue losses and expenses will receive payments through this round of Phase 4 COVID-19 Provider Relief Funds. Through the Health Resources and Services Administration (HRSA), HHS has released the fifth round of Phase 4 COVID-19 Provider Relief Funds, which includes $1.75 billion for healthcare providers that […]
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