Tag: RCM Services

a-snapshot-of-telehealth-payment-policies-across-states

A Snapshot of Telehealth Payment Policies Across States

Telehealth policies vary from state to state but in the past few months there have been some common regulation changes across the country. Specifically, states modified their Medicaid reimbursement policies for telehealth services, the Center for Connected Health Policy’s (CCHP) State Telehealth Laws and Reimbursement Policies Fall 2021 report revealed. CCHP gathered data from state […]
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Humana Expands Medicare Advantage Value-Based Contract in Minnesota

The payer will expand its partnership with Allina Health to cover more members under Medicare Advantage value-based contracts. “This value-based agreement for Humana Medicare Advantage members is an important part of helping our members achieve their best health,” Chuck Dow, vice president and Medicare regional president for Minnesota at Humana. “We’re excited to share with […]
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newly-expanded-supplemental-benefits-medicare-advantage-grew-43-2022

Newly expanded supplemental benefits in Medicare Advantage grew 43% for 2022

Along with that growth, the number of plans offering more than one benefit increased 15%, from 175 to 202. The findings show that under the Centers for Medicare and Medicaid Services’ reinterpretation of “primarily health-related” benefits, supplemental benefit offerings in Medicare Advantage – such as home-based palliative care, in-home support services, caregiver support and therapeutic […]
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steps-you-can-take-to-defend-against-exclusion-of-zero-paid-claims

The Steps You Can Take to Defend Against Exclusion of Zero-Paid Claims

Zero-paid claims are defined as any claims submitted by healthcare providers that are not paid. The problem is that when performing statistical extrapolations, auditors (ZPICs, or Zone Program Integrity Contractors, and others) routinely screen out zero-paid items when they extract the claims from a sample. This is a violation of at least 12 parts of […]
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health-systems-set-sights-on-risk-based-payment-in-medicare-advantage

Health Systems Set Sights on Risk-Based Payment in Medicare Advantage

Over half of health systems also said they plan to advance risk-based payments or some form of capitation in commercial lines of business. The executive survey conducted by the Healthcare Financial Management Association (HFMA) for the Guidehouse Center for Health Insights found that nearly 60 precent of health systems are looking to advance into risk-based […]
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improper-medicare-payments-down-20b-since-2014-cms-data-shows

Improper Medicare payments down $20.7B since 2014, CMS data show

  The number of improper payments made under Medicare fee-for-service declined by $20.72 billion since 2014, according to new figures from the Biden administration. “The continued reduction in Medicare fee-for-service improper payments represents considerable progress toward the Biden-Harris Administration’s goal of protecting CMS programs’ sustainability for future generations. We intend to build on this success […]
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medical-group-revenue-declines-underscore-need-for-efficiency

Medical Group Revenue Declines Underscore Need for Efficiency

The survey found that median provider salary and benefits expense as a percent of net revenue increased from 72.1 percent to 84.9 percent, which is the outcome of provider compensation being protected during the COVID-19 pandemic combined with decreased productivity. In addition, the survey showed a net revenue decrease from 24.2 percent to 22.8 percent […]
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cms-releases-2022-physician-fee-schedule-final-rule

CMS Releases 2022 Physician Fee Schedule Final Rule

The Centers for Medicare & Medicaid Services (CMS) has finalized 2022 payments and policies under the Medicare Physician Fee Schedule (MPFS). The rule includes updates to payment rates for physicians and other healthcare professionals for calendar year (CY) 2022; expands the use of telehealth for mental health; clarifies policies related to split (shared) visits, critical […]
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direct-to-consumer-telehealth-platforms-lag-behind-competition

Direct-to-Consumer Telehealth Platforms Lag Behind Competition

  The pandemic has changed patients’ use and perceptions of healthcare organizations. The question remains: Will those changes here to stay? PATIENTS PREFER TELEHEALTH SERVICES FROM DOCTORS, HEALTH PLANS Most telehealth users accessed virtual care services through their regular doctor or health plan as opposed to direct-to-consumer telehealth platforms, according to new data from Morning […]
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