Businessman holding financial graphics
April 16, 2015
Package payments may be small at the moment, but new programs are expanding across the board. Here's what to know before jumping in.
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Community health center funding cliff could cause more than 100,000 job losses December 12, 2017 | Jeff Lagasse - Healthcare Finance Associate Editor
Centers' ability to provide care to underserved patients will be seriously compromised if the $3.6 billion cut in funding isn't immediately restored.
Healthcare spending growth slowed in 2016 December 12, 2017 | Susan Morse - Associate Editor, Healthcare Finance
Private health insurance continues to be the largest payer for healthcare goods and services, accounting for just over one-third of total spending.
OnBase unveils new platform for increased transparency for payers September 11, 2017 | Mike Miliard - Contributing Editor
Mackinac enables easier collaboration, expedited document sharing between providers and payers, Hyland says.
CSR uncertainty could cause 9.4M uninsured, 37% premium increase, report says September 11, 2017 | Susan Morse - Associate Editor, Healthcare Finance
Insurers must decide whether to assume CSRs will continue, increase premiums, or leave market.
Insurers plan sharp rate hikes next year unless Congress removes uncertainty by appropriating money to pay discounts, about $10 billion in 2018.
4 former national coordinators, a CIO and a CEO weigh in on how to fix meaningful use September 11, 2017 | Tom Sullivan - Executive Editor, HIMSS Media
A rock star lineup of health IT pros including Karen DeSalvo, John Halamka weigh in on where the program went astray and suggest the direction that government and industry should steer towards.
CHIP reauthorization complicated with packed legislative calendar this month September 11, 2017 | Phil Galewitz, Kaiser Health News
A Kaiser Family Foundation survey this summer of state Medicaid officials said 10 states would run out of CHIP funding by end of the year.
NQF says interoperability goes far beyond EHR-to-EHR data exchange September 05, 2017 | Tom Sullivan - Executive Editor, HIMSS Media
The National Quality Forum has released new guiding principles for a truly interoperable healthcare system.
Only 3.3% of emergency room visits are 'avoidable,' study says September 05, 2017 | Susan Morse - Associate Editor, Healthcare Finance
Most patients who are in the emergency department belong there and insurers should cover those visits, ACEP says.
Employers are seeking bundled payment assistance with help from a start-up that makes suggestions about surgery options based on analyzed data.
MGMA: Medical practices focused on customer service, revenue cycle training August 28, 2017 | Beth Jones Sanborn - Managing Editor of Healthcare Finance News
Last year's poll saw MACRA being top of mind, but flexibility with that policy has eased their worry.
Canopy Health to add UnitedHealthcare to unique provider-payer network in California August 28, 2017 | Susan Morse - Associate Editor, Healthcare Finance
The health system pays the claims, accepts the risk of a health insurer, but does not sell coverage directly to consumers.
New bundled payment models will switch power from hospitals to physicians, Altarum says August 22, 2017 | Susan Morse - Associate Editor, Healthcare Finance
Expect CMS to release more voluntary bundled programs by the end of the year that focus on outpatient payments, expert says.
'Mixed' results from payment reform efforts should steer future course, not condemn them entirely, Health Affairs says August 22, 2017 | Beth Jones Sanborn - Managing Editor of Healthcare Finance News
Initiatives attempted "wholesale practice transformation," which yielded little financial gain or improvements in quality, authors wrote.
Litigation underway in fee-for-service vs. managed care coverage in California August 14, 2017 | Emily Bazar, Kaiser Health News
The lawsuit alleges the state illegally reversed doctor and court decisions for patient to remain in fee-for-service Medi-Cal.
Small practices plagued by complexity of Medicare regulations, show dim view of MIPS, MGMA study shows August 14, 2017 | Beth Jones Sanborn - Managing Editor of Healthcare Finance News
Survey evaluated responses from 750 group practices, with largest representation from independent practices, groups of 6 to 20 physicians.
Medicaid's budget bursting over climbing prices of older drugs August 14, 2017 | Sydney Lupkin, Kaiser Health News
Rising costs for 313 brand-name drugs lifted Medicaid's spending by as much as $3.2 billion in 2016.
Texas doctor slapped with 35-year sentence and $268M in restitution for massive fraud scheme August 14, 2017 | Beth Jones Sanborn - Managing Editor of Healthcare Finance News
The Department of Justice said the elaborate fraud scheme "takes brazen to a whole new level."
The Every Prescription Conveyed Securely Act, filed in the U.S. House of Representatives, would mandate e-prescribing for controlled substances under Medicare Part D.
CMS finalizes 90-day reporting for meaningful use August 07, 2017 | Bill Siwicki - Managing Editor of Healthcare IT News
The agency, seeking to ease EHR reporting burdens, will also allow both 2015 and 2014-certified EHRs for 2018.

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How to prepare for bundled payments April 16, 2015 | Sherree Geyer - Contributing Writer
Businessman holding financial graphics
Package payments may be small at the moment, but new programs are expanding across the board. Here's what to know before jumping in.
SGR fix would narrow Medicare physician payment gap March 30, 2015 | Sherree Geyer - Contributing Writer
Dollar sign
Reimbursement rates have essentially been frozen in the absence of an accurate payment formula; meanwhile, doctors are taking on more complex cases than ever.
How it can pay to outsource medical billing March 09, 2015 | Divan Dave - CEO of OmniMD
raining money
Even an excellent in-house biller can't do it all. Consider these areas where it may make sense hire an outside firm.
Electronic data exchange streamlines adjudication February 23, 2015 | Lindy Benton - CEO of MEA/NEA
Coding
Claims processing and other requests for information by outside parties should be expedited and secured through electronic filing.
Why providers should charge like hotels February 09, 2015 | Bill Marvin - CEO of InstaMed
insurance claim papers
Some argue that consumers should be able to view a total price for healthcare services in advance. But that's not a completely effective way to communicate payment responsibility.
5 ways to improve revenue management November 06, 2014 | Johanna Epstein - Vice President of Strategy and Executive Leadership Services at Culbert Healthcare Solutions
Practice revenue cycle management
Medical groups need to examine their revenue cycle systems to determine if they are capable of supporting business and operational goals. These quick recommendations will help you get started.
10 ways to maximize cash flow October 29, 2014 | Frank Irving - Editor
money in pocket
Recommendations for getting the most from your collection efforts and strategies for avoiding costly mistakes.
3 steps for getting your patients to pay up August 04, 2014 | Jeff Wood - Vice President of Product Management at Navicure
dollar bills
More education regarding financial responsibility and options for making payments will go a long way toward reducing expensive claims management work. Here's a proactive strategy for establishing clear and ongoing communications.
Virtual payments: not just a phase July 21, 2014 | Bill Marvin - CEO of InstaMed
dollar bill
They're less expensive for payers than mailing paper checks, so providers should expect rising use of virtual cards. Here's how to successfully handle this emerging form of payment.
Making the case for electronic claims attachments June 13, 2014 | Lindy Benton - CEO of MEA/NEA
computers with binary code
Providers who automate the claims process by going electronic will be paid sooner than those still reliant solely on hard-copy record transmission. And AHIP has the data to prove it.
How to challenge insurance recoupments April 16, 2014 | Madelyn Kearns - Associate Editor
Preparing to challenge insurance recoupments
Recent court rulings support a remedy against payers offsetting alleged provider overpayments against new and unrelated claims.
Survival guide to PQRS March 31, 2014 | Madelyn Kearns - Associate Editor
Survival guide to PQRS
These four best practices will help you qualify for incentives, avoid future penalties, and make reporting quality measures part of your care standard to the benefit of your practice and the patients it serves.
4 tips for more effective collections March 26, 2014 | Kelsey Brimmer - Associate Editor
4 tips for more effective collections
These tactics will help ease the awkward process of making sure patients pay up for healthcare services rendered.
Which financials to track and how often February 26, 2014 | Kavita Sahai - VP Medical BackOps
Financial reports: What to track and how often
There's no way to manage what you do not measure. That's why you need to stay on top of specific accounting measures on a regular schedule.
7 questions to ask before payment auditors come knocking November 26, 2013 | Madelyn Kearns - Associate Editor
7 questions to ask before payment auditors come knocking
Because even honest doctors can find themselves facing an overpayment audit, adhering to these tips will help you survive unscathed.
3 techniques for maximizing accounts receivable November 20, 2013 | Xavier E. Martinez
3 techniques for maximizing accounts receivable
A few straightforward steps can help your practice collect more payments in less time.
4 ways to improve payer-provider relations October 15, 2013 | Salvador Lopez - Content Writer, CareCloud
4 ways to improve payer-provider relations
Forming fruitful relationships with the companies that reimburse your claims can be the difference between getting paid or not.
Making your revenue cycle efficient October 02, 2013 | Brian Fugere - Chief Operating Officer, RemitDATA
Making your revenue cycle efficient
Managing cash flow is a critical function for the practice administrator as well as for the entire revenue cycle staff. Leveraging solutions to monitor and drive performance improvement, along with process mapping, is a quick and easy way to get your cash earlier.
Engaging the patient: Crucial to improved outcomes September 09, 2013 | Janet Duni, RN, BSN, CCM, MPA - Director of Care Coordination at Vanguard Medical Group
Engaging the patient: Crucial to improved outcomes
Vanguard Medical Group, a 20-provider, three-location primary care practice in Northern New Jersey, leverages information technology tools to identify and track high-risk patients and engage them in their care. Using a team-based care model, the goal is for providers to develop a disease-related "action plan" with each high-risk individual.
Getting the most out of your MU dollars September 03, 2013 | Marla Roberts, DrPH, RN - Solution Manager at CTG Health Solutions
Getting the most out of your MU dollars
Even practices that invested early and were ready -- or close to ready -- to achieving the purpose of meaningful use should take another look. Well-placed investments will contribute to sustaining change and setting a solid foundation for escalating MU requirements.

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5 factors casting doubt on the SGR fix March 24, 2015 | Frank Irving - Editor
Frank Irving
Anything can happen in politics -- especially when it involves funding deadlines. But there are reasons to believe the sentiment trending against an imminent, permanent solution.
What will happen with the SGR fix? March 12, 2015 | Frank Irving - Editor
Frank Irving
Cast your vote on the likelihood of another patch or a permanent solution being passed by Congress by March 31.
Top talking points: Suite payment models, vaccination and virtual reality February 13, 2015 | Madelyn Kearns - Associate Editor
Welcome back to "Doc Talk." For this installment, we delve into the concept of charging patients like hotels, the best way to deal with anti-vaxers and the prospect of virtual reality in healthcare.
AMA responds to HHS goal-setting for Medicare reimbursements January 27, 2015 | Robert Wah, MD - President of the American Medical Association
Robert Wah, MD
Government's efforts align with the physician association's work toward care delivery reform.
Look who's talking about the frustrations of meaningful use January 09, 2015 | Madelyn Kearns - Associate Editor
Madelyn Kearns
Welcome back to "Doc Talk." This week, we focus exclusively on what you and your fellow providers had to say about meaningful use and why you're not attesting for Stage 2.
It's time to update telehealth payment policy December 17, 2014 | Krista Drobac - Executive Director of the Alliance for Connected Care
Krista Drobac
Obsolete qualifications for Medicare beneficiaries counteract the care-provision capabilities of today's technology.
Why you need to get a handle on denials November 13, 2014 | Carl Natale - ICD10Watch
Carl Natale
Start now with a denial management strategy so that you're not scrambling to cope with reimbursement delays after the ICD-10 deadline.
ICD-10 hasn't gone away, nor has the drive to improve the overall claims management process. At the same time, data analytics are scaling down to small practices.
The cowboys of healthcare costs August 13, 2014 | Jeff Rowe - Contributing Writer
cowboy
Culprits are driving America's healthcare costs upward by as much as a half-trillion dollars. Are you one of them?
Providers face Medicaid dilemma July 24, 2014 | David Williams - Health Business Blog
David Williams
In many states, doctors who take care of a high proportion of Medicaid patients will find themselves in financial distress. That's not fair to them or their patients.
The basic healthcare transaction July 17, 2014 | Rob Lamberts, MD
Rob Lamberts, MD
The provider is rewarded for finding the best-paying procedure code to match the most severe problem codes. Where is the patient in all this?
This weeks top commentary: Doc rankings, healthcare spending and ACOs June 13, 2014 | Madelyn Kearns - Associate Editor
doc talk quote
Welcome to this week's "Doc Talk," wherein we discuss doctor reputations and rankings, healthcare spending after ACA, and patient agency.
The Affordable Care Act is here -- and you have leverage January 17, 2014 | Tom McGuinness, CPA, CVA - Founding Partner, Reimer, McGuinness & Associates, P.C., Boyle Henderson, Jr., CPA - Director of the Healthcare Practice at Daenen Henderson & Company
Tom McGuinness
Insurance plans are pleading for your participation in their plans.
Physicians remain anxious over lack of SGR progress December 04, 2013 | Stephanie Bouchard - Managing Editor, Healthcare Finance News
Stephanie Bouchard
No one has been successful in getting repeal legislation passed, largely because a viable plan for paying for it has yet to be developed.
Bipartisan SGR bill could fix more than just the Sustainable Growth Rate December 04, 2013 | Dan Haley - Vice President, Government and Regulatory Affairs, athenahealth
Dan Haley
With the right modifications, the SGR bill could make a meaningful difference in Medicare reimbursement, ensuring that all doctors are treated fairly, paid for their services, and able to seamlessly share valuable patient information.
The absolute case for relative value units December 02, 2013 | David Williams - Health Business Blog
David Williams
Maybe we should adapt RVUs to the new environment of alternative payment models rather than throwing them out the window.
The rollout of the Affordable Care Act October 23, 2013 | Tom McGuinness, CPA, CVA - Founding Partner, Reimer, McGuinness & Associates, P.C.
tom mcguinness
As a consultant to physicians, my advice at present is to collect your fees up front. This is based upon practice survival skills learned from years in the trenches.
Washington, we have a problem September 23, 2013 | Rob Lamberts, MD
Rob Lamberts, MD
There is pressure now to respond to each "problem" with a procedure, or at least something to eliminate it as a problem.
Tax planning for 2013 August 19, 2013 | Tom McGuinness, CPA, CVA - Founding Partner, Reimer, McGuinness & Associates, P.C., Marc H. Lion, CPA, CFP - Founding Member, Lion & Co., CPAs LLP
Tom McGuinness
If you haven't already run a 2013 tax projection based upon 2012 income, it's time to do so now.
Should we care if doctors drop Medicare? August 06, 2013 | David Williams - Health Business Blog
David Williams
Does it really make sense to use an insurance mechanism for routine, relatively low-cost expenditures such as primary care?

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CMS names Pulse Systems a qualified PQRS Registry for 2014 May 29, 2014 | Medical Practice Insider Staff
Eligible Providers using the Pulse Complete EHR or PulsePro Practice Management solutions can increase their Medicare reimbursement while improving patient care.
Proven Florida Track Record and Personalized Service Seals the Deal.
Navicure Launches Navicure Receivables Manager November 13, 2012 | Industry Release
Navicure, a leading Internet-based medical claims clearinghouse for physician practices, today announced the release of its new Navicure Receivables Manager, a central repository for insurance denials, appeals and payments, that streamlines denial and appeal management by automating the entire process. The solution, which is an evolution of Navicure’s ERA Filing Cabinet, helps physician practices decrease days in A/R, accelerate cash flow and improve staff productivity.
ADP AdvancedMD, a leader in all-in-one, cloud-based electronic health record (EHR), practice management (PM), and medical scheduling software as well as medical billing services, today announced a webinar titled “Preparing for the 2013 Medicare Cut and Improving Your Practice’s Long Term Financial Performance,” with Frank Irving, editor of PhysBizTech and Anne M. Dunne, Director of Healthcare Management Consulting, Grassi & Co, an ADP AdvancedMD partner. The complimentary webinar takes place on Thursday, October 18 from 12-12:30 p.m. Eastern / 9-9:30 a.m. Pacific time. Participants will learn about the Centers for Medicare and Medicaid Services’ (CMS) rule imposing a seven percent reduction in specialists’ pay for 2013, on top of proposed “sustainable growth” reductions of 27 percent.
WebPT, developer of Web-based software that makes rehab clinics more efficient, has partnered with CollaborateMD, a Web-based medical billing software provider. The integration with CollaborateMD is part of WebPT’s move beyond EHR to become a comprehensive solution for rehab clinics. WebPT’s EHR system gives therapists an easy, secure, Web-based system for their documentation needs, along with real-time practice management services to improve clinic workflow.
WebPT, developer of Web-based software that makes rehab clinics more efficient, has partnered with CollaborateMD, a Web-based medical billing software provider. The integration with CollaborateMD is part of WebPT’s move beyond EHR to become a comprehensive solution for rehab clinics. WebPT’s EHR system gives therapists an easy, secure, Web-based system for their documentation needs, along with real-time practice management services to improve clinic workflow.
26% of primary care physicians report poor financial health in the most recent QuantiaMD Physician Wellbeing Index. This financial instability, coupled with mounting professional challenges, and a dearth of incentives, are major factors driving new physicians away from primary care and into more lucrative subspecialties. This trend is especially worrying at a time when key aspects of the Patient Protection and Affordable Care Act (ACA) rely heavily on primary care physicians for success.
Colorado Beacon Community partner Rocky Mountain Health Plans (RMHP) will be part of a project to re-envision the role of behavioral health in primary care. If it succeeds, the effort could transform the nation's approach to behavioral health by better integrating the delivery of behavioral and physical health care.
In order to receive reimbursement for patient claims, U.S. healthcare providers must begin using a revised global system for classifying medical diagnoses and inpatient procedures by Oct. 1, 2014.  While more than two years sounds like plenty of time to implement a new system, the number of possible diagnostic codes will increase dramatically from 14,000 to 68,000, while the number of inpatient codes will increase from 4,000 to 87,000. Crowe Horwath LLP, one of the largest public accounting and consulting firms in the U.S., suggests steps that providers can implement ahead of the conversion deadline for a smoother transition.
WorkSmart MD, Inc. has announced its launch of medicalbillinghelper.com an educational website that helps physicians and community health centers (FQHC) improve their profitability and maximize medical billing revenue.
A new ICD-10 financial impact analysis tool and comprehensive ICD-10 financial impact consulting services are the latest additions to the full suite of ICD-10 transition planning solutions offered by 3M Health Information Systems. The new software and services are designed to help healthcare organizations analyze the reimbursement impact of ICD-10 in order to identify and target critical revenue and operational impact areas for improvement.
 A recent global analysis of product evaluations for Health Technology Assessments  – which are often influential in decision making for approving and/or providing reimbursement for pharmaceuticals and other medical technology – found that the use of patient-reported outcomes (PROs) increased between 2005 and 2011. The study also showed substantial variation across both nations and treatment areas in applying HTAs to such decisions.
WebPT, developer of cloud-based software that makes clinics more efficient, now offers a revenue cycle management service in addition to its industry-leading EHR system for physical therapists. Leveraging a team of deeply experienced billing specialists, WebPT is now offering a complete, turnkey solution to make billing and collections more efficient.
 When physicians see patients outside of their office (in the hospital, at a surgery center, in nursing homes), they typically scribble their charges on whatever paper is nearby and deliver it to the billing staff once they return to the office. Physicians are looking for a more accurate and reliable way to capture these charges without slowing them down.
Netsmart, the leading provider of clinical solutions for health and human services organizations nationwide, today launched Netsmart Plexus Revenue Cycle Management, a comprehensive billing and revenue management service that provides health and human services providers with an efficient, cost-effective solution to manage their financial health and increase the efficiency of their billing and collections processes.