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Hospitals lose appeal to block CMS’ price transparency rule A federal appeals court has ruled against hospital groups in their legal challenge to the CMS regulation that would require hospitals to make pricing information publicly available. The rule is set to take effect Jan. 1. Despite hospital...

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would improve the electronic exchange of health care data among payers, providers, and patients, and streamline processes related to prior authorization to reduce burden on providers and patients....

October 07, 2019 - The time to strengthen hospital compliance programs through claim validation is now. According to healthcare finance and information management leaders surveyed by HIMSS Media, clinical documentation and coding were the revenue cycle processes most vulnerable to errors that could result in lost or decreased revenue. These issues...

HOW WILL THE NEW FLORIDA MEDICAID INPATIENT PROSPECTIVE PAYMENT SYSTEM AFFECT YOUR HOSPITAL? July 1st 2013 Florida Inpatient Medicaid reimbursement changed from a per diem rate to an Inpatient Prospective Payment System. With any major change in payment methodology, there are always winners and losers. Regardless...

The reductions in Medicare payments that will result from the implementation of the Affordable Care Act started last year and will continue to increase during the next years. They were supposed to be somewhat offset by the increase in people eligible for insurance–either due to...

I keep hearing “we have to do…to be compliant…or we can’t do…because it would be a compliance issue” and a lot that I hear really doesn’t make sense to me, so I’ve done some research to try to clarify “compliance” issues. In 1998, the OIG published...

When we started as a healthcare consulting firm, 20 years ago, none of our hospital clients had a chargemaster coordinator on staff, let alone a chargemaster committee. Individual hospital departments operated in a vacuum from a charging perspective. These days things are very different and...

So, let’s think about this: all big payers–Medicare, Medicaid, Blue Cross, Aetna, United, Cigna, Harvard Pilgrim, etc–have their own reimbursement rules. So, why do you bill them all according to Medicare’s reimbursement rules? And please note, payment rules are NOT billing rules. But that’s another...

Automation can be a wonderful tool in the healthcare revenue cycle.  It can cut down on payment processing time, provide real reimbursement numbers for reporting and free up personnel for other tasks.  But like most other industries, there are pitfalls to automating your accounts receivables....

Are you so afraid of the new laws that you’ve become paralyzed? Are you so afraid that charging for your services will be called “non-compliant” that you’re giving your services away? Are you so afraid of being “non-compliant” that you’ve forgotten that in order to accomplish your...