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.

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

 
A program that combines a mobile app, analytics and direct intervention is showing promise in reducing the costs associated with hospitals' most expensive patients -- the so-called "super-utilizers."
Comment count:
Post date: September 19, 2014
News
For U.S. community health centers, the recent announcement of $295 million in Affordable Care Act funding was welcome news. But the five-year period of mandatory ACA funding expires next September, meaning CHCs face a reduction of up to 70 percent in grant funding.
Comment count:
Post date: September 19, 2014
News
California's lingering backlog of Medi-Cal applications has left hundreds of thousands of people unable to access the healthcare they are entitled to receive, according to a lawsuit filed Wednesday.
Comment count:
Post date: September 18, 2014
News
The value-based model of healthcare is gradually transitioning from the pilot phase to implementation, as health insurers and providers strive to offer better care while eliminating unnecessary costs. But for providers who have always been paid fee-for-service, it is a different way of thinking.
Comment count:
Post date: September 17, 2014
News
Predictive analytics uses a variety of statistical techniques that analyze current and historical facts in order to make predictions about the future. In the healthcare setting, such data analysis can be effective in addressing a variety of key issues, including preventable readmissions.
Comment count:
Post date: September 16, 2014
News
Weill Cornell Physicians, Cornell University's physician group, has inked a new accountable care agreement with Aetna, intended to enhance care for approximately 9,000 of the insurer's commercial and Medicare members in New York.
Comment count:
Post date: September 11, 2014
News
As regional payers and providers take the first steps to begin working together in the era healthcare reform, one area they can start with is the issue of readmissions.
Comment count:
Post date: September 11, 2014
News
US not-for-profit children's hospitals are likely to remain financially stable in the next year or two although changes on the horizon, including those related to healthcare reform, could affect the sector's traditional niche role.
Comment count:
Post date: September 10, 2014
News
Accountable care organizations are captivating because they contain elements of care delivery that most experts agree should improve healthcare: financial risk sharing, electronic health records, quality benchmarks, patient engagement and care coordination. But the question remains: can ACOs pull it off?
Comment count:
Post date: September 5, 2014
News
A new analysis of hospital readmissions allows state Medicaid medical directors to better understand the nature and prevalence of hospital use in the Medicaid population, and provides a baseline for measuring improvement.
Comment count:
Post date: September 3, 2014
News
The 340B program is critical for hospitals and other providers that serve some of our country's poorest and most vulnerable patients. When providers monitor compliance and track 340B drugs properly, the program can fulfill its intended purpose.
Comment count:
Post date: September 2, 2014
News
Healthcare organizations of all sizes continue to struggle with rapidly evolving models of population health-oriented reimbursement, according to a new report from Chilmark Research.
Comment count:
Post date: August 29, 2014
News
The Centers for Medicare & Medicaid Services has published a final rule updating the hospice wage index and payment rate for Fiscal Year 2015. It adopts a number of payment reforms addressing concerns about program integrity, beneficiary protection and quality.
Comment count:
Post date: September 22, 2014
Blog
In its new rules, CMS places great emphasis on the physician's documentation regarding his or her expectation of a patient's need for hospital care and anticipated length of stay. Therefore, it is essential that all hospital physicians are educated about the heightened importance of documentation within the medical record.
Comment count:
Post date: September 15, 2014
Blog
In its new rules, CMS places great emphasis on the physician's documentation regarding his or her expectation of a patient's need for hospital care and anticipated length of stay. Therefore, it is essential that all hospital physicians are educated about the heightened importance of documentation within the medical record.
Comment count:
Post date: September 15, 2014
Blog
Congress returned on Monday with just a few weeks until they adjourn to campaign. The Senate is set to adjourn by September 23 while the House could be in session for as little as 2 weeks. Here's a look at what happened in healthcare while Congress was in recess.
Comment count:
Post date: September 12, 2014
Blog
Inpatient rehabilitation services are already a big target area for recovery audit contractors, and there will likely be more denials as audits ramp back up. Providers must remain consistent, proactive and vigilant to protect their revenue.
Comment count:
Post date: September 8, 2014
Blog
While others have dispassionately made the point that there are unexplained variations in Medicare physician billing data that warrant careful consideration when using such data, one doctor thinks CMS has devious motives.
Comment count:
Post date: September 4, 2014
Blog
Accountable care has taken a stronghold in today's healthcare environment, and the trend is progressing, according to respondents from Premier's semiannual Outlook survey.
Comment count:
Post date: September 2, 2014
Blog
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.
Comment count:
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.
Comment count:
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?
Comment count:
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.
Comment count:
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.
Comment count:
Post date: July 23, 2014
Blog