Category: Revenue Cycle Management

The Biden Administration Drug Plan Includes Value-Based Payment Ideas for Medicare

The Biden Administration Drug Plan Includes Value-Based Payment Ideas for Medicare

The administration said it would make the results of its drug price negotiations with manufacturers, as well as its approach to value-based care models, open to a variety of payers. The Biden administration Thursday released its plan to reduce prescription drug prices, which would include the use of models to test value-based payments in Medicare […]
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How Ambulatory Surgery Centers Lower Payer Outpatient Spending

How Ambulatory Surgery Centers Lower Payer Outpatient Spending

Payers can reduce surgical costs by 59 percent by shifting eligible members from the hospital outpatient setting to ambulatory surgery centers. Ambulatory surgery centers are care sites that offer surgical procedures, diagnostics, and preventive care services, according to the Ambulatory Surgery Center Association. These sites are not provider offices, rural healthcare clinics, or urgent or […]
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Leaked CMS Report Targets Medicare Noncompliance at CA Hospital

Leaked CMS Report Targets Medicare Noncompliance at CA Hospital

A leaked CMS report targeting HCA Healthcare-owned Good Samaritan Hospital in California warns the hospital to fix Medicare noncompliance issues or risk termination. A leaked CMS report put HCA Healthcare-owned Good Samaritan Hospital in California at risk of program termination by October if they fail to fix Medicare noncompliance issues that resulted in patient harm. […]
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Follow these 5 steps to Ensure HIPAA-compliance when texting patients

Follow these 5 steps to Ensure HIPAA-compliance when texting patients

As long as providers remain HIPAA-compliant, they will be able to text patients with ease and see all the benefits that it brings — including stronger patient loyalty, more revenue, and more referrals. Many people, and that includes patients, prefer to text because it’s quick, easy, and convenient. Texting is incredibly effective for medical practices […]
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UnitedHealthcare loses Medicare Advantage overpayment suit

UnitedHealthcare loses Medicare Advantage overpayment suit

Dive Brief: A federal appeals court has ruled against UnitedHealthcare, the biggest private payer in the U.S., and reversed a 2018 decision overturning Medicare’s overpayment rule requiring insurers to refund reimbursement to CMS within 60 days if they learn a diagnosis lacks medical record support. UnitedHealthcare argued in court in November the overpayment rule was […]
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Dos And Don’ts For Managing Inpatient-to-observation Status Downgrades

Dos And Don’ts For Managing Inpatient-to-observation Status Downgrades

  In the newest episode of the HealthLeaders Revenue Cycle Podcast, Charlie Brown, MBA, a former hospital executive and vice president of revenue cycle at a consulting firm, provides actionable steps for mitigating status downgrades and dealing with them effectively to ensure that organizations receive the full reimbursement for the services they provided. In his […]
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