Accurate RAF Scores Could Mean Billions in Savings for Medicare

June 20th, 2019 / Judi Cahill / Posted in GeBBS Healthcare Solutions, Medicaid, Medicare

A recent study published by the Kaiser Family Foundation sheds light on a complex issue – how to determine the real or predicted cost of care for Medicare Advantage plan members when establishing RAF scores is based on the inexact science of provider documentation. The study released this spring indicated that those who were enrolled …

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Five-Year Growth Explosion Anticipated for Medical Billing Outsourcing

June 6th, 2019 / Judi Cahill / Posted in Coding Outsourcing, GeBBS Healthcare Solutions, Medical Coding, Medical Coding Outsourcing, Offshore Medical Billing, Outsource Coding, Value-Based Care

The administrative costs associated with medical billing within a physician practice are becoming unmanageable for independent and major health-system affiliated practices alike. A 2018 research study was conducted by experts at Duke University and Harvard designed to examine the administrative costs specific to large academic medical centers using electronic health record (EHR) technology – and …

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Keeping an Eye on Value-Based Care – 3 Things to Watch

May 15th, 2019 / Tyler Cowart / Posted in Technology, Value-Based Care

“Work smarter, not harder.” This age-old philosophy is the mantra behind value-based health care. After all, more health care doesn’t necessarily mean better outcomes – this much has been proven by evidence-based medicine time and again. As the fee-for-service model of health care slowly fades away, true value-based care (and all the benefits that come …

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With Telehealth on the Rise, Policy & Payers Are Catching Up

May 10th, 2019 / Tyler Cowart / Posted in Accountable Care Organizations (ACOs), Medicare, Telehealth

Telehealth is a key element of our country’s health care transformation – and health care providers, payers and patients are getting on board today more quickly than ever. After all, getting timely and convenient medical diagnosis and treatment using your computer, phone or tablet – anywhere, anytime, is of incredible value in our busy, technology-driven …

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Shedding Light on Alternate Payment Models

May 2nd, 2019 / Tyler Cowart / Posted in Accountable Care Organizations (ACOs), CMS, Coding Accuracy, Medicaid, Medicare

The shift to value in healthcare is no easy feat. While the Centers for Medicare and Medicaid Services (CMS), accountable care organizations (ACOs) and healthcare systems are all working towards it, true success requires a commitment to collaboration, communication and transparency.

Why the Government is Outsourcing (and You Should, Too)

April 30th, 2019 / Tyler Cowart / Posted in Accounts Receivable (A/R), Health Information Management (HIM), Revenue Cycle Management (RCM)

The data is clear – policymakers are making every effort to reduce healthcare costs, particularly as states struggle with significant budget deficits across the country. To do this, many state governments have elected to outsource the management of Medicaid and Medicare programs to managed care companies. According to Modern Healthcare, 34% of Medicare beneficiaries are …

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

April 23rd, 2019 / Tyler Cowart / Posted in Coding Accuracy, Medical Coding, Remote Medical Coding

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) …

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

April 4th, 2019 / Tyler Cowart / Posted in Accounts Receivable (A/R), Offshore Medical Billing, Outsourced Medical Billing, RCM Solutions

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 …

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

March 29th, 2019 / Tyler Cowart / Posted in RCM Solutions

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 …

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

March 15th, 2019 / Tyler Cowart / Posted in Gebbs Healthcare

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 …

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