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Mapping ICD-9 to ICD-10 ‘Convoluted,’ Experts Say

Healthcare providers should plan for substantial disruption of billing and reimbursements upon switching to ICD-10 on Oct. 1, 2014, according to the results of an exhaustive study that attempted to map...

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Do Medicare Readmission Penalties Unfairly Target Safety-Net Hospitals?

Are safety-net hospitals unfairly burdened by the new Medicare penalties on facilities with higher relative readmission rates? Reading between the lines of a recent report by the California HealthCare...

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Inspector General Wants CMS to Scrutinize G Modifiers

Within the arcane science that rules Medicare claims, there are the “G modifiers,” which providers use to notify Medicare that a particular bill may not qualify for reimbursement. But then Medicare...

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Maintaining Your Integrity through Healthcare Data Integrity

The main source of legitimate complaints about healthcare provider collections are mistakes, and almost always data errors. The more data errors you have, the lower the quality of your data integrity....

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Congress Agrees: Change How Healthcare Providers Get Paid

It may be too early to hold hands and sing “Kumbaya,” but leadership in the House of Representatives and Senate for once agree on something: We must change the way Medicare pays health providers. In...

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Hospitals Sought to Test Bundled Payment

The Centers for Medicare and Medicaid Services (CMS) has reopened its search for hospitals interested in testing a bundled payment model. On Friday CMS published notice in the Federal Register that it...

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CMS Publishes Formula Cutting Disproportionate Share Hospital Reimbursement

Last week’s the Obama administration made noises about postponing cuts to disproportionate share hospitals, but when the regulations came out, the cuts were there in black and white. The new...

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IPF on Forbes: Newly Insured No Boon to Physician Bottom Line

In this week’s blog post on Forbes.com, I write about the problems the newly insured will have finding healthcare, based on the results of ”Practice Profitability Index ,” a survey and analysis by...

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IPF on Forbes: Fight Medicare Fraud Like Credit Card Companies

Over at Forbes.com you’ll find a high-level summary of the current state of the battle over Recovery Audit Contractors (RACs). While most healthcare providers are abreast of the latest developments,...

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House of Representatives Seeks Input on Bill Scrapping ‘Doc Fix’

Congress is preparing to eliminate the Sustainable Growth Rate (SGR, sometimes known as the “Doc Fix”) formula and wants to hear from healthcare providers and others if its proposed replacement is...

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Medicare Given Two More Years to Live

Medicare’s Board of Trustees announced last week that it has projected the program’s life will extend another two years to 2026 But as any physician knows, predicting how long someone will survive is a...

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Hospitals Appealing RAC Denials in Record Numbers

Centers for Medicare & Medicaid Services (CMS) Recovery audit contractors (RACs) are denying more claims than ever, but hospitals are throwing those denials back at them in the form of an...

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American College of Physicians Offers 19-Point Plan to Replace SGR

Last month the Senate Finance Committee called for stakeholders to provide recommendations to replace the Sustainable Growth Rate (SGR) formula, and last week the American College of Physicians weighed...

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You’ve Selected an Outsource Partner for Your Conversion Project. Now What?

Editor’s Note: This article is the first in a two-part series by Roberta Schultz, a follow-up to her April story, “Don’t Let Your Billing System Conversion Break Your Revenue Cycle.” The second...

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Four Building Blocks to Bring Your Outsource Partner into the Fold

Editor’s Note: This article is the first in a two-part series by Roberta Schultz, a follow-up to her April story, “Don’t Let Your Billing System Conversion Break Your Revenue Cycle.” The first...

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Putting Context around Projections of Medicare Health

Medicare’s projected solvency may have been extended two years to 2026, but the consensus among pundits and even Medicare’s Board of Trustees is that it is a best guess based on shaky assumptions....

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Hundreds of Doctors Involved in Medicare Scam, Lab President Claims

Hundreds of doctors in New York and New Jersey allegedly conspired with a medical laboratory to defraud Medicare, the president of that laboratory told the NBC affiliate in New York. Scott Nicoll,...

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Criticism of NYT Story on Colonoscopy Prices Rolls In

Last week’s New York Times article that attempted to make colonoscopies the poster child for the high cost of healthcare in the United States received a failing grade from the healthcare industry. Last...

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The Five Must-Haves When Selecting a Medical Debt Collection Partner

Your relationship with your healthcare collection partner is like a marriage, and it is not unusual for a healthcare provider and collection partner to have been together for years. But there will come...

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Busting the Myth About Money Behind Lab Tests

Doctors who have no financial incentive to order laboratory tests will send their patients to the lab as often as those who do, a new study has found. Researchers at the Malcom Randall Veterans Affairs...

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