Read more about the article Encounter Data & Why Getting It Right is More Important Than Ever

Encounter Data & Why Getting It Right is More Important Than Ever

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Earlier this month, CMS announced changes to future payments for Medicare Advantage plans that will take effect in 2020. While a pay raise is part of the plan, what’s causing a stir is that payment will now be based on a higher percentage of patient encounter data (up to 25% from 10%). Many (especially payers) have argued that encounter data is often incomplete and inaccurate when compared to diagnoses, since encounter data relies on provider documentation.

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Read more about the article Is It Time for a Billing Operations Check-Up? How to Assess the Health of Your Revenue Cycle

Is It Time for a Billing Operations Check-Up? How to Assess the Health of Your Revenue Cycle

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Balancing the competitive landscape that comes with physician practice consolidation combined with population health and the shift to value-based care is a lot to consider for busy hospital physician practices. Add in the constant changes in regulatory guidelines, enhancing the patient experience and most importantly – a continued focus on quality and safety and most hospital administrators have little resources left to focus on improving the revenue cycle.

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Read more about the article 3 Ways Hospitals Can Improve Their CMS Star Rating (Regardless of its Flaws)

3 Ways Hospitals Can Improve Their CMS Star Rating (Regardless of its Flaws)

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Lots of questions and headlines began swirling earlier this month after the Centers for Medicare and Medicaid Services (CMS) released its hospital star ratings – a “seemingly” simple system designed to help consumers make informed decisions about hospitals and the care they deliver. While consumers are used to 5-star ratings for hotels and restaurants, the healthcare industry is clearly far more complex. As such, a cloud of mystery and skepticism surrounds this incredibly powerful rating system – especially for the thousands of hospitals who participate in Medicare and are therefore automatically subject to stardom whether they like it or not.

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Read more about the article 800 Hospitals Forfeit 1% of Revenue to CMS For Poor Performance

800 Hospitals Forfeit 1% of Revenue to CMS For Poor Performance

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Last week, CMS reported that 800 hospitals will be required to forfeit 1 percent of their reimbursement for missing the mark on reducing hospital-acquired conditions (HACs). The race to eliminate preventable patient harm has always been a top hospital goal, but now it’s one tied to their reimbursement through the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program (HACRP). No matter how hard hospitals work to improve their performance, CMS will penalize the lowest performing quartile (25%) of hospitals annually.

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Read more about the article CMS Will Only Adjust Medicaid Rules – Not Drastically Change Them

CMS Will Only Adjust Medicaid Rules – Not Drastically Change Them

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After much ballyhoo and for years of promising a major overhaul to the cost-prohibitive Obama-era managed care rules, the CMS has issued a proposed regulation that makes smaller changes – not the drastic “gutting” that had been promised — to the standards states meet when running their Medicaid plans.

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