Category: Revenue Cycle Management

Reimbursement for COVID Testing and Vaccination

CMS Moves to Streamline Coverage and Reimbursement for COVID Testing and Vaccination

Federal officials are ordering plans and insurers to cover testing without cost-sharing – for virtually any purpose. Federal officials have issued new guidance intended to streamline the process through which Americans can get easy, free access to COVID-19 diagnostic testing and/or vaccinations. “This guidance makes clear that private group health plans and issuers generally cannot […]
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Healthcare Automation

Advancements in Automation Are Cutting Into the Rising Costs of Manual Healthcare Transactions

Inefficiency is an issue that continues to plague many areas of healthcare, particularly when it comes to manual administrative functions. While the industry is increasingly harnessing technology – evidenced by the use of telehealth and the push for electronic health record interoperability – administrative complexity continues to be burdensome, and largely paper- and fax-driven. This […]
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Telehealth Security

Best Practices to Ensure Telehealth Security and Protect Patient Data

  To support the sudden increase in test results and medical records being transmitted during the pandemic, hospitals, laboratories, and pharmacies implemented additional devices and remote connections into their networks. After the Office for Civil Rights (OCR) lifted penalties around telehealth to expand care options amid the crisis, new platforms were adopted that were not previously allowed […]
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Social Determinants Lowered ED Utilization

Addressing Social Determinants Lowered ED Utilization in Medicare

A CMS-run care delivery model focused on addressing social determinants of health has effectively identified higher cost and utilization patients while reducing potentially unnecessary emergency department (ED) visits, a new report shows. The Accountable Health Communities (AHC) Model reduced hospital ED visits by 9 percent for Medicare fee-for-service beneficiaries screened for health-related social needs, including housing instability, […]
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Denials Management v Denials Avoidance

Denials Management Versus Denials Avoidance: CDI Can Capitalize

  Typical CDI programs are intended to drive reimbursement through diagnosis securement, contributing to improved case mix index. The COVID-19 pandemic is placing monumental financial stressors upon hospitals, with added costs to treat patients with high acuity and long length of stays, coupled with significant revenue loss associated with postponement of more profitable elective surgeries, […]
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Clinical Documentation Improvement Vendors

Clinical Documentation Improvement Vendors Gaining Momentum

The clinical documentation improvement (CDI) vendor landscape has undergone significant changes over the last couple of years, including vendor acquisitions and technology developments. And these changes and other factors have had an impact on customer experience, according to a recent KLAS report. For example, vendors like Iodine, Optum, and 3M have gained momentum over the past […]
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Advanced Technology for Reimbursement

Advanced Technology Will Help Drive Reimbursement Change

Telehealth, remote monitoring will boost patient outcomes and value-based care results Limited by the slow pace of change in traditional reimbursement models, shifts in the paradigm for patient care have also lagged far behind the possibilities created by transformative technology. The COVID-19 pandemic has changed that, catalyzing improvements in reimbursement by both commercial and government […]
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Telehealth Cybersecurity

Industry Voices – How To Tackle Telehealth Cybersecurity Threats

  Many healthcare organizations quickly adopted telehealth programs out of necessity at the start of the COVID-19 pandemic, expanding their attack surface with the integration of new technology such as mobile telehealth apps and wearable heart rate and blood glucose level monitors. What’s more, nearly half of security researchers (48%) believe the healthcare industry is […]
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Medicare Coverage Rule

CMS Releases Highly Anticipated Medicare “Breakthrough” Coverage Final Rule

The final rule also clarifies the definition of “reasonable and necessary.” On Jan. 14, the Centers for Medicare & Medicaid Services (CMS) published a final rule creating a new Medicare coverage and reimbursement pathway for “breakthrough” medical devices. Durable medical equipment (DME) providers and long-term care facilities (LTCFs) and hospitals that render DME services, read on! Medical device […]
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Medicaid Physician Reimbursement Rates

Medicaid Physician Reimbursement Rates Lag Medicare

Medicaid physician reimbursement rates in the fee-for-service part of the program were about 72% of Medicare rates for the same service, a new study finds. Medicaid physician reimbursement is significantly lower than commercial payer and even Medicare payments for the same services despite growing enrollment in the public healthcare program, reveals a new Urban Institute study. […]
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