Tag: RCM Services

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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cms-provides-additional-arp-funding-states-promote-insurance-affordability

The CMS provides additional ARP funding to states to promote insurance affordability

The Centers for Medicare and Medicaid Services and the Biden Administration have earmarked $452 million in federal funding through the ARP  funding to Health insurance program for efforts to lower costs and improve health insurance access in 13 states. Due to the changes made to the ARP, states with 1332 reinsurance waivers will have more […]
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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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cms-faces-calls-to-improve-remote-patient-monitoring-coverage-in-2022-pfs

CMS Faces Calls to Improve Remote Patient Monitoring Coverage in 2022 PFS

Telehealth advocates are submitting recommendations to CMS to improve coverage for remote patient monitoring services in the proposed 2022 Physician Fee Schedule. With remote patient monitoring projects surging in popularity as a result of the pandemic, telehealth advocates are lobbying the Centers for Medicare & Medicaid Services to improve proposed coverage plans in the 2022 […]
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cms-seeks-to-improve-healthcare-outcomes-and-drive-down-costs

CMS Seeks to Improve Healthcare Outcomes and Drive Down Costs

CMS’ proposed actions are intended to increase price transparency, access to care, patient safety, positive healthcare outcomes, and health equity. On July 19, 2021, the Centers for Medicare & Medicaid Services (CMS) announced new proposed actions to address the health equity gap, decrease mounting healthcare costs, and increase medical accessibility and patient quality of care. […]
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cms-prior-authorization-operational-and-financial-impact

CMS Prior Authorization—operational And Financial Impact

CMS has expanded the prior authorization requirement to two new service categories within hospital outpatient department services. The Centers for Medicare & Medicaid Services (CMS) has expanded the prior authorization requirement for two additional hospital outpatient department (OPD) services. Effective with date of service July 1, 2021, CMS has expanded the prior authorization requirement to […]
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Hospital Price Transparency Strategies for Compliance, Patients

Hospital price transparency is now a requirement from CMS, but providers should be going beyond the rule to ensure transparency meets patient demands, too. Hospital price transparency goes beyond just compliance with federal regulations. Patients are also demanding more transparent pricing information from their providers in order to make more informed decisions about their healthcare. […]
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New Rules Issued for Modifiers 59, XE, XS, XP, and XU

The Centers for Medicare & Medicaid Services (CMS) issued a policy change modification to the claims processing logic for Modifier 59 Distinct procedural service (and the optional patient-relationship modifiers XE, XS, XP, and XU) on February 15, 2019. These modifiers are only processed when applied to the Column 2 code in a bundled pair, per Correct Coding Initiative […]
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5 Ways to Ensure RCM Efforts Don’t Leave Money on the Table

A frequent knock on electronic health records has been that they’re just glorified billing systems that fail to provide enough clinical functionality to make a significant difference in quality of care. So it’s somewhat incongruous that a recent Black Book report on revenue cycle management (RCM) system adoption would say that 26 percent of hospitals […]
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