Are you in confusion over COVID-19 coding and claim requirements?

According to a new survey that confusion over COVID-19 medical coding and insurance claim requirements is one of the top effects the pandemic has had on revenue cycle management in the healthcare industry. Alpha Health conducted a survey through the Healthcare Financial Management Association’s Pulse program, they inquired 587 chief financial authorities and revenue cycle […]

Impact of Pandemic on Value-Based Contracts

The Healthcare industry is facing implications from the pandemic situations that can impact their ability to improve contract performance and potentially expose them to new risks. Value-based contracts are usually relying on historical data for starting claim targets, trend rates, and/or quality measures. Impact on claims The timing and severity of this pandemic situation is […]

AHA wants improvements for Accelerated Medicare Payments

The American Hospital Association (AHA) is calling on CMS to re-evaluate payment options for hospitals that accepted accelerated Medicare payments at the early stage of the COVID-19 pandemic. The hospital group requested CMS Administrator Seema Verma to allow all hospitals to elect to receive periodic interim payments (PIP) or accelerated payments, per initial CMS communications […]

CMS and CDC – Provider Reimbursement Update

The CMS (Centers for Medicare and Medicaid Services) and CDC (Centers for Disease Control and Prevention) recently announced provider reimbursement update available to physicians and health care providers to counsel patients, at the time of coronavirus disease 2019 (COVID-19) testing. Providers educate patients about the importance of self-isolation once they are tested and prior to […]

Are you Prepared for Repayment of Medicare Loans?

Early in August 2020, the Medicare Accelerated & Advance Payment Programs will start to recover the $100 billion in Medicare reimbursements advanced to hospitals and physicians to ease cash flow issues they experienced in March when a handful of COVID-19 cases turned into a national public health emergency. Major hospital groups are asking Congress to […]

Healthcare Providers Paycheck Protection Program Loans

The paycheck protection program is a key resource for small healthcare organizations and the program is established by the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This act provides loans up to USD 10 million for businesses with fewer than 500 total employees. The loans can be fully forgiven if at least 60 percent […]

Oncology Care Model (OCM) are willing to take on two-sided risk

Oncology practitioners in CMS’s Oncology care model (OCM) are willing to take on two-sided risk, according to the Community Oncology Alliance (COA) survey. The oncology practitioners are confident they can get success in providing quality and cost-effective cancer care as the healthcare system undergoes the shift from fee-for-service to value-based care. Community Oncology Alliance surveyed […]

Account receivable services in Healthcare

“Account Receivable” (AR) is a widely used term referring to the amount of money that a customer owes to the company. Similarly, in the healthcare industry, AR means the patient’s account balance becomes due for payment within a year. Account receivable services include the management of many reports dealing with insurance, collection analysis, write-offs, bad debt […]

Transition to value-based reimbursement is essential for Health disparities

Value-based reimbursement inspires clinicians to care for the whole person, who is essential to addressing health disparities confirmed by claims data from the COVID-19 crisis, CMS says. Health disparities confirmed by Medicare claims data for the period of the COVID-19 crisis underscore the need to transition to value-based reimbursement, according to CMS. Health disparities evident in the […]

Quality Payment Program Performance Results

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) enforced CMS to implement an incentive program called the Quality Payment Program as MACRA ended the Sustainable Growth Rate (SGR) formula, which significantly cut payment rates for participating Medicare clinicians. Now, clinicians can choose the following ways to participate in the Quality Payment Program: Merit-based […]

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Revenue Cycle Management (RCM)