Tag: RCM Services

AHIP warns proposed ACA exchange rule could threaten market’s growing stability

AHIP warns proposed ACA exchange rule could threaten market’s growing stability

  AHIP, the top lobbying organization for commercial insurers, is warning the feds that provisions in its proposed rule governing the Affordable Care Act’s exchanges for 2023 could “undermine” the growing stability there. For instance, the group says in comments (PDF) submitted late Thursday that potential changes to requirements for essential health benefits would limit […]
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Surprised Providers Seek Changes to Latest Provisions of the No Surprises Act

Surprised Providers Seek Changes to Latest Provisions of the No Surprises Act

Effective January 1, 2022, new billing protections went into effect that have the goal of providing greater protections for patients against surprise medical bills. The Departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management (collectively, the Departments) implemented these additional protections that are part of the No Surprises Act […]
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CMS Proposes Changes to Medicare Advantage and Part D Programs

CMS Proposes Changes to Medicare Advantage and Part D Programs

On January 12, the Centers for Medicare & Medicaid Services (CMS) released the Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs proposed rule, representing CMS’ first major policy proposals for these programs in the Biden Administration. The changes proposed are, overall, modest in scope. In the […]
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Revenue cycle management 2.0: The key to successful healthcare finance

Revenue cycle management 2.0: The key to successful healthcare finance

This has, in turn, put greater emphasis on the need for Revenue Cycle Management (RCM) systems to enable a healthcare provider to better manage transactions between payer, provider and patients. It can, through the use of various software platforms, boost revenues, reduce denials and enhance the patient experience. According to a survey published by health […]
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Electronic Payment Key to Streamlining Healthcare Claims Management

Electronic Payment Key to Streamlining Healthcare Claims Management

The complexity around healthcare claims management is a major pain point for provider organizations, big and small. The increasing cost of claims coupled with a complex system of many payers, each with their own rules and requirements, creates administrative burdens and obstacles for providers. Ultimately, this complex system impacts the patient experience, as patients must […]
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How The Affordable Care Act Impacted Small Group Coverage Trends

How The Affordable Care Act Impacted Small Group Coverage Trends

Small group coverage did not pursue the trends that many experts anticipated after the Affordable Care Act went into effect. From 2013 to 2020, small group coverage has maintained a fairly stable environment, researchers from the Urban Institute found. The researchers used the Medical Expenditure Panel Survey Insurance Component (MEPS-IC) in order to assess changes […]
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CMS Updates Affordable Care Act, Public Payer Enrollment Numbers

CMS Updates Affordable Care Act, Public Payer Enrollment Numbers

Affordable Care Act enrollment for 2022 and public payer enrollment midway through 2021 saw some record-breaking surges. In 2020 and 2021, public payer and Affordable Care Act marketplaces experienced major disruptions and changes that continue to have ripple effects. The year that the pandemic struck, Medicaid and CHIP enrollment escalated for the first time in […]
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Medicare Advantage, consolidation drove healthcare insurer trends in 2021

Medicare Advantage, consolidation drove healthcare insurer trends in 2021

  COVID-19 continued to affect the industry, which has plowed forward with expanded offerings, digital transformation and other bold moves. It was difficult to predict trend lines for the payer and health insurance industry in 2021, largely because of persistent uncertainties due to the COVID-19 pandemic. Consumer behavior has become more unpredictable, care models and […]
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Physician Fee Schedule Final Rule for Calendar Year 2022 – CMS Cuts Rates and Extends Telehealth

Physician Fee Schedule Final Rule for Calendar Year 2022 – CMS Cuts Rates and Extends Telehealth

On November 2, 2021, the Centers for Medicare and Medicaid Services (“CMS”) issued its Calendar Year (CY) 2022 Physician Fee Schedule (“PFS”) Final Rule. In this post, we sample some key highlights from the Final Rule. For more detail, take a look at our previous post, in which we highlight the PFS’s changes to the […]
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