Tag Archives: Centers for Medicare & Medicaid Services

Build an ICD-10 rapid response team for revenue emergencies

Now that ICD-10 is a reality in the U.S. health care environment, providers are finding that October 1, 2015, didn’t bring with it the D-Day scenario they thought it might. But they also know ICD-10-related challenges that aren’t apparent now might manifest themselves in the coming months. Providers were certainly ready to submit claims come […]
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10 tips for working with MCOs to advance Medicaid program integrity

Have you turned to managed care organizations (MCOs) to reduce Medicaid costs and improve patient care? If so, you probably know how difficult it is to know for sure whether your MCOs are doing all they can to reduce fraud, waste and abuse. In May 2015, CMS proposed a new rule that MCOs strengthen their […]
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Positive signs in early results — reasons for optimism regarding ICD-10 productivity

One of the biggest unknowns of the ICD-10 implementation is the effect on coding productivity. Experts have estimated the expected loss in productivity post-ICD-10 as HIM professionals climb the learning curve, and studies of other countries’ post-ICD-10 loss unveil valuable insights. One of the best studies on time loss published in 2014 revealed that participants […]
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Client-focused solution tracks and educational sessions take center stage at Optum Forum.

Maximizing investments and elevating organizational performance was the focus at Optum Forum Thursday as provider and health plan clients engaged with Optum experts and industry peers in solution focused tracks and educational sessions. Several sessions were led by clients who have implemented Optum solutions to better manage processes within their own organizations. Case studies, demos […]
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Inspiring change and transforming care around consumer needs resounding message from day two of Optum Forum

Two influential leaders visibly moved a packed audience of nearly 1,200 executives and professionals from organizations across the health care industry with their keynote addresses. After sharing personal stories of his background and professional experiences, General Colin L. Powell, USA (Ret.) talked about the power we have to transform not only ourselves but where we […]
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Debate and discovery drives first day of Optum Forum.

The first day of Optum Forum is in the books, but the dialogue it generated will certainly continue. In his opening remarks at the Executive Forum, Bill Miller, CEO of OptumInsight, emphasized that this week is about engagement and the opportunity to learn from each other. In its third year, Optum Forum continues to provide […]
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Transforming health care together: The 2015 Optum Forum starts today

Addressing the health care system’s most pressing challenges is the focus of the third annual Optum Forum, which begins today at the Gaylord National Resort and Convention Center in National Harbor, Maryland, on the banks of the Potomac River across from Washington, D.C. This innovative event merges two conferences, the Optum Executive Forum and the […]
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A saving grace? What the new grace period does and does not mean for ICD-10 unspecified coding

With the recent Centers for Medicare and Medicaid Services (CMS) announcement of a ‘grace period’ related to ICD-10 coding specificity for Part B physician claims, there is a spotlight on unspecified ICD-10 codes. But how much will HIM leaders need to worry about unspecified codes? According to a recent review of more than 30,000 dual-coded […]
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Ditching MMIS full-system procurement for a “services-only” approach: A quick “how-to” on administrative operations

Adopting a service-based Medicaid Management Information System (MMIS) approach may require that you reorganize some of your administrative operations. For example, you’re probably using your MMIS for capitation payments and the collection of encounter data — but you don’t have to. You can make capitation payments through your finance system and feed your encounter data […]
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Rethinking your MMIS? A services-only approach does qualify for enhanced FFP.

Many people have asked whether a service-based model for Medicaid Management Information System (MMIS) qualifies for enhanced federal funding. The answer is yes. As you know, the federal government requires states to undergo certification to receive enhanced Federal Financial Participation (FFP), which pays 90 percent for MMIS implementation and 75 percent for ongoing operations. What […]
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