Revenue Cycle Management


This section includes coverage on the many facets of the revenue cycle food chain for hospitals and physician group practices. Topics span insurance eligibility, charge capture, claims coding, claims submissions, claims clearinghouses, and back-end follow-up with insurance companies to rectify claims denials and resubmission requests.


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eHealth Initiative Studies the I.T. of ACOs

Joseph Goedert | Feb 10
A new report from stakeholder advocacy group eHealth Initiative explores the health information technology infrastructure needed to support accountable care organizations.
Disease Management
Health Info Exchange

Fairly Shocking: The Feds as an Efficiency Leader?

Greg Gillespie | Feb 10
My father wasn’t the first or last to say that it will be a sad day indeed if the private sector ever gets lapped by the feds in terms of efficiency.
Coding
Group Practices

Docs to Get $200 Million in Settlement for Underpaid Claims

Joseph Goedert | Feb 09
In 2009, UnitedHealth Group agreed to settle for $350 million a lawsuit the American Medical Association filed charging the insurer with underpaying for out-of-network services. Now, a federal judge has issued rulings to release $200 million to settle claims that physicians filed against UnitedHealth.
Group Practices
Policy & Regulation

McKesson Buys peerVue to Enhance Radiology Workflow

Joseph Goedert | Feb 09
McKesson Corp. has acquired peerVue Inc., a vendor of radiology workflow management software, for an undisclosed sum.
Medical Imaging
Hospitals

Survey Ranks ‘Fairness’ of Payer Reimbursements

Joseph Goedert | Feb 07
A survey from IVANS Inc., a transactions processing vendor, finds large numbers of its provider customers believe Medicare and Medicaid reimburse more fairly than commercial insurers, even though the government plans pay less.
Electronic Data Interchange
Policy & Regulation

HIT Vendor Round-up: AdvancedMD, Medicity, Keane & T-System

Joseph Goedert | Feb 06
Acquisitions, name changes and new products are among recent initiatives from health information technology vendors.
Group Practices
Health Info Exchange

CMS Demo Programs Will Require Providers to Do More to Justify Claims

Joseph Goedert | Feb 03
The Centers for Medicare and Medicaid Services is getting ready to launch two new data collection programs, affecting providers and their revenue streams by making them further justify claims submitted for payment.
Electronic Data Interchange
Payers

MGMA Asks HHS for More Time, Fixes to HIPAA 5010

Joseph Goedert | Feb 02
The Medical Group Management Association has sent a letter to HHS Secretary Kathleen Sebelius outlining significant problems with federal reimbursement of claims following the transition to the HIPAA 5010 transaction sets.
Electronic Data Interchange
Coding

Rule Would Boost Payment for Primary Care

Joseph Goedert | Feb 02
The Centers for Medicare and Medicaid Services expects soon to publish a proposed rule that will have significant revenue ramifications for primary care physicians.
Group Practices
Hospitals

5010 – Ready or Not, Here It Comes (Part 3 of 3)

Jackie Griffin | Jan 31
There is absolutely no denying it now – HIPAA 5010 is here, and we’re all feeling the weight of it. Over the past few weeks, I’ve been presenting on 5010 with associations and talking with representatives from all different areas of the industry to get a feel for the main points of pains that are out there.
Coding
Electronic Data Interchange

HIT Vendor Round-up: Castlight, MedAssets & Aprima

Joseph Goedert | Jan 31
Several health information technology vendors have recently announced new initiatives, including:
Consumer Health
Decision Support

GAO: Medicare Overpaying for Medicare Advantage

Joseph Goedert | Jan 31
A study by the Government Accountability Office finds differences in diagnostic coding between Medicare Advantage plans and traditional Medicare fee-for-service coverage.
Payers
Coding

AHIMA: AMA Stance on ICD-10 Should Not Slow Down Work

Joseph Goedert | Jan 30
With the American Medical Association ramping up its fight against the ICD-10 code sets by asking House Speaker John Boehner for assistance in stopping mandated implementation, the American Health Information Management Association is warning against slowing down compliance work.
Coding
EHR

HIT Vendor Round-up: New Client Wins

Joseph Goedert | Jan 30
A number of health information technology vendors have announced new customer wins in recent days.
Hospitals
Health Info Exchange

Sorting the Reform Law Options Before the Supreme Court

Joseph Goedert | Jan 25
President Obama in March 2010 signed into law the Patient Protection and Affordable Care Act, implementing enormous changes in the U.S. health care industry. Almost immediately, opponents of the law filed lawsuits challenging its constitutionality.
Policy & Regulation
Payers
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A major success factor for accountable care organizations will be linking caregivers across the spectrum of care delivery. If history is any indication, that's going to be an industrywide struggle.

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