Reimbursement

Reimbursement for services is what keeps providers in business. Hospitals and clinics draw from a number of different payers for reimbursement, including Medicare, Medicaid and private insurance companies. Reimbursement can be affected by the claims process, out-of-network payments, denials, audits and legislation. The fee-for-service model of healthcare has been hotly debated in the pages of Healthcare Finance News, as Congress, insurers and healthcare providers work together on establishing reimbursement rates and fee schedules that work for the entire industry.

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A newly released scorecard by the AARP Policy Institute, with support from The SCAN Foundation and The Commonwealth Fund, ranks states on how well each delivers long-term services and supports to older adults and people with disabilities.
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Post date: August 20, 2014
News
Low-income consumers struggling to pay their premiums may soon be able to get help from their local hospital, but the hospitals' efforts have set up a conflict with insurers.
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Post date: August 14, 2014
News
Medicare's Hospital Insurance Trust Fund won't run out of money until 2030. That’s four years later than projected last year and 13 years later than projected the year before the passage of the Affordable Care Act.
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Post date: July 29, 2014
News
A Pennsylvania provider is suing a health insurance company for passing on its 2 percent reimbursement cut required by sequestration.
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Post date: July 29, 2014
News
When it comes to speeding up the revenue cycle, the hospital pharmacy has its own part to play.
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Post date: July 28, 2014
News
As payers and employers put pressure on providers to assume more financial risk, providers are struggling to assess the impact of the risk they have already assumed.
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Post date: July 25, 2014
News
With patients paying more out-of-pocket costs and exchanges increasing the number of plans providers deal with, having financial counselors in a practice may become a necessity.
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Post date: July 23, 2014
News
South Nassau Communities Hospital CFO Mark Bogen spoke with Healthcare Finance News about risk, controlling costs and revenue challenges for his Oceanside, N.Y.-based organization.
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Post date: July 23, 2014
News
Medicare officials have allowed patients at dozens of hospitals participating in pilot projects across the country to be exempted from the controversial requirement that limits nursing home coverage to seniors admitted to a hospital for at least three days.
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Post date: July 22, 2014
News
Hospitals are increasingly making reducing hospital-acquired infections and readmissions a priority -- and saving millions of dollars in the process -- but there are still gaps to be filled.
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Post date: July 22, 2014
News
Medicare announced Friday that it was revising rules intended to prevent the agency from paying twice for the same prescriptions for seniors receiving hospice care. The drug categories in question were identified in a 2012 investigation by the HHS inspector general.
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Post date: July 21, 2014
News
Hospitals participating in Independence Blue Cross' accountable care contracts are reducing costs, improving care and earning incentives, according to the Philadelphia-based insurer.
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Post date: July 18, 2014
News
Imagine trying to run a successful business when employers, competitors, and other service providers have launched focused campaigns that encourage consumers to avoid you. If you run a restaurant or an auto-repair shop, this scenario is far-fetched. If you run a hospital, it's reality.
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Post date: August 8, 2014
Blog
Just in case you didn't get the memo earlier this week, hospitals should take note that the Centers for Medicare & Medicaid Services will soon allow Recovery Auditors to restart some reviews.
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Post date: August 7, 2014
Blog
Chief financial officers at hospitals and health systems must track a multitude of difficult financial issues these days. One question, however, always stops a conversation cold: Why are our reimbursements declining?
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Post date: August 7, 2014
Blog
Last month the Centers for Medicare & Medicaid Services published its proposed rule to update the Medicare Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment System rates and policies for calendar year 2015. Here's what you need to know.
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Post date: August 6, 2014
Blog
Medicaid beneficiaries deserve the same access to healthcare services and products as people with commercial insurance or Medicare. But since Medicaid pays doctors and hospitals 27 to 65 percent less than commercial health plans, it makes it awfully difficult for providers to be payer agnostic.
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Post date: July 23, 2014
Blog
Even though it has not been determined what impact the health insurance exchanges will have on hospital finances, there are steps hospitals can take to increase the likelihood of positive effects on their revenue cycles.
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Post date: July 22, 2014
Blog
Even though it has not been determined what impact the health insurance exchanges will have on hospital finances, there are steps hospitals can take to increase the likelihood of positive effects on their revenue cycles.
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Post date: July 22, 2014
Blog
Even though it has not been determined what impact the health insurance exchanges will have on hospital finances, there are steps hospitals can take to increase the likelihood of positive effects on their revenue cycles.
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Post date: July 22, 2014
Blog
Business has a vital concern in the financing of healthcare. So why is there not an outcry to switch to a proven financing system that would serve their employees well?
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Post date: July 17, 2014
Blog
One of the worst failures of the Affordable Care Act is that, even with subsidies, the premiums and out-of-pocket expenses are unaffordable for far too many people. Unfortunately, a new proposal for catastrophic plans with very high deductibles would make accessing healthcare truly unaffordable for even more people.
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Post date: June 16, 2014
Blog
Hospital revenue fell in 2014's first quarter compared with the final three months of 2013, the Census Bureau estimated last week. And for a full year -- from Q1 2013 to Q1 2014 -- revenue for healthcare and social assistance rose only 2.9 percent.
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Post date: June 16, 2014
Blog
Healthcare reform and the shift toward value instead of volume underscore the importance of population health management for improving patient outcomes on a large scale. One essential component of a comprehensive population health program is patient access.
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Post date: June 9, 2014
Blog