Revenue Cycle Management

Several key trends are reshaping the business strategies of health insurers in advance of the Jan. 1 go-live date for many provisions of the Affordable Care Act.

The trend of providers owning health plans took a big step forward in New York last week when the state approved North Shore-LIJ Insurance Company's application for an insurance license.

Medical claims denials are a hassle and can lead to financial difficulties and yet so many of them can be easily avoided.

The Centers for Medicare & Medicaid Services issued a notice this week increasing prospective payment rates for hospital-based and freestanding Medicare inpatient psychiatric facilities by an average 2.3 percent for fiscal year 2014.

Since providers must be able to pay rent and staff salaries if the transition to ICD-10 does not flow smoothly, experts advise having up to several months' cash reserves or access to cash to avoid potential headaches.

Medicare patients' chances of being admitted to the hospital or kept for observation depend on what hospital they go to -- even when their symptoms are the same, says a new report by the HHS Inspector General.

In advance of August 1, when drug, device and biological companies, medical supply manufacturers and group purchasing organizations will be required to collect and document marketing expenses under the Physician Payments Sunshine Act, pharmaceutical and medical device companies have been preparing but they're still laboring to adapt.

As healthcare delivery and reimbursement models transition to ensuring quality care versus quantity of care, some sectors of the healthcare industry will benefit more than others.

Real-time claims processing can result in financial benefits, so healthcare technophobes need to get on board.

CMS' Pioneer Accountable Care Organization Model requires a degree of patience that many of the participating organizations couldn't afford, as evidenced by the recent announcement that nine are leaving the program.