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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ERISA can help health organizations obtain full reimbursement
House to HHS: No more cuts to cancer care reimbursement

 
Medicare Advantage managed care plans surpass outcomes of regular Medicare
A new analysis of more than 3 million claims for Medicare patients found that patients enrolled in a managed Medicare Advantage plan had better health outcomes than those senior enrolled in the traditional fee-for-service Medicare model.
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Post date: May 17, 2013
Chris Anderson
News
Aging not the overwhelming driver of higher healthcare spending as thought
A new report by the Society of Actuaries has found that aging is not as overwhelming a driver of increased healthcare spending as is generally believed.
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Post date: May 16, 2013
Mary Mosquera
News
Feds take down 89 people in eight cities in Medicare fraud totaling $223 million
The federal government has uncovered a string of alleged Medicare fraud attempts totalling $223 million and involving 89 individuals in eight cities.
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Post date: May 15, 2013
Anthony Brino
News
Quality improvements seen for SNFs
A new report examining the state of the skilled nursing industry finds that there have been steady quality improvements since 2003 but more can be done.
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Post date: May 14, 2013
Stephanie Bouchard
News
Value-based payments picking up steam
The number of health plans that expect more than half their business will be under value-based models is expected to triple in the next five years according to a new research report released last week by health information network Availity.
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Post date: May 13, 2013
Chris Anderson
News
Analysis examines quality measures
A recent policy analysis from the National Institute for Health Care Reform (NIHCR), written by Carrier and other researchers from the center, reviews the various types of quality measurements and discusses ways in which payers can help make quality information more available, reliable and usable.
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Post date: May 10, 2013
Kelsey Brimmer
News
CMS publishes hospital price data
In an effort to take the first steps toward a more transparent pricing structure in the U.S. healthcare market, the Center for Medicare & Medicaid Services yesterday published nationwide hospital charge data showing wide variations in how much Medicare pays for services in different markets.
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Post date: May 9, 2013
Chris Anderson
News
Fraud recoveries on the rise
The healthcare industry is on notice: Fraud recoveries in the healthcare sector are on the rise and whistle-blowers are the biggest weapon in the fight against fraud.
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Post date: May 8, 2013
Stephanie Bouchard
News
Medical director duties tied to quality
In the last few years the scope of responsibilities and duties delegated to medical directors has been evolving to include more responsibility over measures of quality within their healthcare organizations.
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Post date: May 8, 2013
Kelsey Brimmer
News
EHR incentive payments top $13B
Continuing the upward trajectory of EHR reimbursements flowing out into the healthcare industry, the Centers for Medicare & Medicaid Services said on Tuesday morning that the total paid as of March's end is more than $13.7 billion.
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Post date: May 8, 2013
Tom Sullivan
News
Physicians have low Medicaid acceptance
An analysis from HealthPocket raises the specter that individuals who obtain health coverage under Medicaid starting in 2014 will have to dig to find a clinician who will treat them.
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Post date: May 7, 2013
Mary Mosquera
News
Insuring the uninsured
Getting uninsured Americans covered by insurance is not just a goal of the federal government's. It has also become a goal of the American Hospital Association's and at its annual membership meeting in April, a panel discussion focused on how to reach that goal.
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Post date: May 6, 2013
Kelsey Brimmer
News
Here Come the Cuts
As the dust settles from the Supreme Court's ruling on the constitutionality of the Affordable Care Act (ACA), the results of the presidential election and, more recently, the sequester cuts, acute care providers are now turning attention to the looming reimbursement cuts.
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Post date: April 15, 2013
Kevin Laidlaw
Blog
What lessons does the European approach to drug reimbursement have for the US?
In Europe, reimbursement decisions for drugs often include explicit consideration of cost effectiveness and a comparison of the efficacy of the new drug with products that are already available.
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Post date: April 10, 2013
David Williams
Blog
Hospice quality reporting deadline fast approaching
Hospices take note: the April 1, 2013 deadline to submit the NQF #0209 data for Payment Year 2014 in the Hospice Quality Reporting Program, or HQRP, is approximately two weeks away.
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Post date: March 14, 2013
Richard Pizzi
Blog
Who will save the independent physicians?
I was only a little bit surprised to read The Doctor’s Office as Union Shop, which blames the Affordable Care Act (ACA) for ushering in “a potentially radical factor in the transformation of health care –the doctor as union worker.”
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Post date: February 5, 2013
David Williams
Blog
Getting charged for rework in a hospital
In Reducing surgical complications: How to make it happen faster, I contrasted the way a hospital gets paid for rework with what happens in a manufacturing environment.
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Post date: January 7, 2013
David Williams
Blog
Facility fees for hospital-owned physician offices: A nasty surprise for patients
When hospitals purchase free-standing physician offices they often convert them into outpatient clinics. The shift isn’t visible on the surface, but underneath the covers a powerful economic transformation has taken place, with the new owners now able to charge a so-called “facility fee” to cover the cost of their infrastructure.
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Post date: December 18, 2012
David Williams
Blog
A phased approach to accountable care can ensure a sustainable financial future
As more healthcare organizations plan to begin their transition to accountable care, it has become clear that there are a variety of factors that influence where they are ready for these changes.
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Post date: December 4, 2012
Chris Day
Blog
Health insurance is expensive
Bloomberg highlights the challenges many of the newly insured will have in paying for coverage, even with the substantial subsidies available to those with lower incomes.
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Post date: December 3, 2012
David Williams
Blog
Healthcare reform puts primary care clinics in hospitals' scopes
Every hospital executive wants to keep healthcare costs down which is why as hospitals are integrating provisions of healthcare reform into their care model, affiliating with and developing primary care clinics is of growing interest.
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Post date: November 16, 2012
James Ellis and Aaron Razavi
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Mad dash to Medicaid: 2 cost saving techniques for hospitals treating a high volume of medicaid patients
With a conservative estimate of 16 million people being added to Medicaid in 2014, hospitals are in a sense of urgency to find cost cutting techniques.
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Post date: September 7, 2012
James Ellis and Aaron Razavi
Blog
Why an aspirin taken in a hospital can cost upwards of $25
Many patients take their first look at a hospital bill, only to go into sticker shock. A single aspirin for $25? Newborn diapers for $100? Why is it that products we purchase for pennies at the local drug store end up costing so much more in the hospital?
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Post date: August 30, 2012
Mike Alkire
Blog
5 steps U.S. states can take to combat Medicaid fraud
As states across the country work to expand Medicaid and build health insurance exchanges, one challenge they will surely face is fraud.
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Post date: August 30, 2012
Clint Fuhrman
Blog