Healthcare Finance News | Reimbursement

Per capita spending on healthcare services for people with private, employer-sponsored health insurance who were younger than 65 rose 3.3 percent in 2010, a rate more than double that of inflation according to a new report from the Health Care Cost Institute (HCCI).

Pennsylvania hospitals report uncertain financial future

May 21, 2012 |

Following the release of a financial report last week by the Pennsylvania Health Care Cost Containment Council (PHC4), the Hospital & Healthsystem Association of Pennsylvania (HAP) has said that the state's hospitals will be facing an uncertain financial future.

Conifer Health inks 10-year revenue cycle pact with CHI

May 17, 2012 |

Conifer Health Solutions, a subsidiary of Tenet Healthcare Corp., announced yesterday a 10-year revenue cycle management deal for 56 Catholic Health Initiatives (CHI) hospitals that will also see CHI acquire a minority stake in Conifer.

Research finds readmission rates linked to availability of care, socioeconomics

May 17, 2012 |

According to research that was presented last week at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions 2012, the differences in regional readmission rates for heart failure are more closely connected with the availability of care and socioeconomics rather than with hospital performance or a patient's degree of illness.

OIG pressures CMS on home health sanctions

May 14, 2012 |

Stephanie Bouchard

As the number of home health agencies and fraud cases related to home health agencies continues to skyrocket, the Office of Inspector General (OIG) is exerting more pressure on the Centers for Medicare & Medicaid Services (CMS) to fulfill an obligation that is 15 years old.

Aetna program aims to increase in-network referrals

May 11, 2012 |

A new national program from Aetna that seeks to lower the number of out-of-network referrals for outpatient surgical procedures will actively alert both members and their doctors if they are leaving the insurer's network for care and work to shift the referral to an in-network provider.

HHS to provide $11B to help states raise primary care Medicaid reimbursements

May 10, 2012 |

In a move that anticipates the increase in the number of people insured through state Medicaid programs as a result of the Affordable Care Act, the U.S. Department of Health and Human Services announced yesterday a two-year, $11 billion program that will help states bring Medicaid payments for primary care services in line with those paid by Medicare.

Increase in consumer-directed health plans could save $57B annually

May 8, 2012 |

A new study from Rand Corp. published in the May edition of Health Affairs indicates that consumer-directed health plans could save $57 billion annually if they grew to comprise 50 percent of all employer-sponsored health insurance in the U.S.

Pennsylvania hospitals face $5B Medicaid shortfall

May 7, 2012 |

The Hospital and Healthsystem Association of Pennsylvania (HAP) released new data last week showing Medicaid payments falling short of costs by $5.28 billion between 2011 and 2015.

HHS signals intent to provide $1.9B to Oregon for Medicaid overhaul

May 7, 2012 |

The U.S. Department of Health and Human Services last week gave tentative approval to provide $1.9 billion in initial funding to help Oregon overhaul its Medicaid system, which the state says has the potential to save $11 billion over 10 years.

Eligibility quiz saves San Diego hospitals $5M in self-pay revenue

April 27, 2012 |

With the help of a two-year task force effort with the Foundation for Health Coverage Education (FHCE), Sharp HealthCare in San Diego has saved $5 million from self-pay patient reimbursements at four of their busiest emergency departments.

CMS issues final rule on Medicare fraud, GAO wants more done

April 25, 2012 |

Bernie Monegain

CMS announced its final rule for preventing Medicare fraud Tuesday, while the GAO issued a report requesting more action be taken.

Maximizing Healthcare Payment Automation

June 2, 2011 |

More than half of the transactions within the US healthcare industry are still paper-based. In addition, there is a processing lag if the payment is paper and the remittance is electronic. Several major challenges plague the healthcare industry’s quest to automate the payments process, and many healthcare providers, billing companies, and banks serving healthcare providers undertake a costly, time-consuming journey to achieve full healthcare payment automation. This session explores the barriers to full healthcare payment process automation and a cost-effective, simple solution for overcoming the barriers.

Improving Point of Service Collections: A Rural Hospital Perspective

March 2, 2012 |

In this webinar, hear how Saint Alphonsus Medical Center, a critical access hospital located in eastern Oregon, increased upfront cash collections and improved patient satisfaction by incorporating patient payment estimation technology into their workflow. Michelle Paoletti, Patient Access Manager, will describe how her organization transitioned to a culture of point-of-service collections by having meaningful payment discussions with patients upfront. Additionally, Michelle will reveal what's next for Saint Alphonsus, including their plans to streamline the financial assistance process.

Disrupting Hospital Based Care: The Innovation Race to Establish 21st Century Care Models

March 2, 2012 |

Intel and Healthcare IT News invite you to an exclusive executive webcast featuring internationally renowned speakers, Jason Hwang, MD co-founder and Executive Director of Healthcare at Innosight Institute, a non-profit social innovation think tank based in Watertown, Massachusetts and Eric Dishman, Intel Fellow and Global Director of Health Innovation and Policy for Intel Corporation.

How new technology is helping healthcare providers meet the pressing challenges of reducing bad debt by improving patient billing and collection

February 14, 2012 |

This paper examines the significant impact of recent changes in the healthcare market on the ability of healthcare organizations to collect payment from patients. The escalating amount of deductibles to be paid by patients off-site is creating a void as to where and when they pay, which in turn is creating less impetus to pay. These changes are set to drive the uptake of new technological advancements in Electronic Bill Presentment and Payment (EBPP) in the Healthcare industry.

Creating the Foundation for Financial Health in 21st Century Healthcare Provision

February 1, 2012 |

SPi Healthcare and Frost and Sullivan will address how the financial health of today's healthcare providers is being severely challenged in an era where fundamental factors are clashing.

Advanced Coding Technology to Advance the Revenue Cycle

February 1, 2012 |

Not all computer-assisted coding solutions (CAC) are created equal. Understand the key elements of natural language processing (NLP) and how the precision of Optum's LifeCode® NLP technology can boost coder accuracy and productivity, improve revenue integrity, and mitigate the financial impacts of the ICD-10 conversion.

How Revenue Cycle Improvements Increase POS Cash Collections, Reduce Bad Debt and Improve Patient Satisfaction

November 7, 2011 |

In today's market of uncertainty and change, healthcare executives must learn to adapt their business processes or continue to fall behind the curve in information technology and analytics. Additional regulations, declining reimbursements and the increase in patient out-of-pocket expenses are squeezing margins that were already razor thin. Healthcare executives are left to wonder, "How can I do more with less?" In an effort to answer this question, Scott Hawig, VP of Finance for Shands HealthCare at the University of Florida, will discuss how his organization is incorporating technology, data and analytics into their revenue cycle processes to improve the patient experience and drive better financial outcomes.

Deceased Patient Receivables: Four Factors for Successful Recovery

October 25, 2011 |

Deceased debt - money owed by the estates of decedents - makes up a significant part of most healthcare organizations’ accounts receivable, a share that may approach 100 percent for hospice-care facilities and other specialized providers. Although recovery of this debt can generate meaningful revenue streams in exchange for very modest investments, many providers pursue it ineffectively or outsource it to non-specialists who deliver poor results and introduce avoidable costs and risks. This paper outlines the revenue opportunity available by recovering deceased patient receivables, shows where current approaches fall short, and describes the four essential elements of a successful recovery program.

Simplifying Medicare Cost Reporting through the use of Report Analytics

September 2, 2011 |

The purpose of the Web seminar is to discover how Bon Secours Charity Health System is using Monarch technology to simplify the process for developing the annual Medicare Cost Report. A specific focus will be how to prepare exhibit 11 (worksheet A.).

Ensuring Proper Reimbursement for Hospital-administered Drugs

July 28, 2011 |

Hospitals fail to secure millions of dollars in revenue due to absent, incomplete and incorrect pharmaceutical data in their billing systems. Based on recent research and case studies, this paper explores the problems underlying pharmacy-based revenue leakage and presents an effective, affordable solution.

RAC Best Practices: Utilization Management

July 13, 2011 |

"Wrong setting" denials have become a primary source of take-backs by Medicare's Recovery Audit Contractors. Arm yourself with these facts before you fight medical-necessity denials.

Innovating Bad Debt and Charity Care Processing

July 11, 2011 |

The old saying goes "no margin, no mission." Today, economic challenges coupled with changes in the healthcare industry bring new light to that expression. More than ever, health systems need to think creatively about how they use resources and help patients. In 2010, Bon Secours redesigned its process for approving charity care; allowing the revenue cycle team to repurpose expensive FTEs and realize savings through efficiency. Join Nick Dawson, administrative director of community engagement for Bon Secours Virginia Health System, as he discusses Bon Secours's approach to charity care, the process redesign, and the data and automation tools which made the redesign possible.

Medical real estate industry 2012 trend report part 1

April 13, 2012 |

What are some of the biggest factors impacting the medical real estate market in 2012?

The Start of Big Changes with Healthcare Costs

March 8, 2012 |

James C. Bohnsack

Recently, the Agency for Healthcare Research and Quality (AHRQ) released survey results that found that just one percent of Americans accounted for 22 percent of healthcare costs in 2009.

CMS reschedules Hospital VBP call for Feb. 28

February 27, 2012 |

Richard Pizzi

The Centers for Medicare & Medicaid Services plans to hold its reschedule National Provider Call on Tuesday, Feb. 28 to discuss its Dry Run of the Fiscal Year 2013 Hospital Value-Based Purchasing Program.

Reduced reimbursement rates keep a hold down on medical real estate development

February 21, 2012 |

Healthcare reform is by far the most dissected, discussed and debated topic in the medical industry. Federally mandated healthcare legislation, and the yet to be determined detailed fine print, influences every decision a hospital executive considers on a daily basis.

How Obama's budget will affect Medicare beneficiaries

February 17, 2012 |

Kelly Mehler

This week, President Obama released a $3.8 trillion budget plan that would construct $360 billion in savings from Medicare, Medicaid and other healthcare programs over a span of 10 years. The cuts are familiar to most, yet some democrats oppose numbers included in the proposal.

Medicare providers don't want less revenue

February 13, 2012 |

Roger Collier

The Congressional Budget Office’s January issue brief on the failure of almost all of more than thirty Medicare demonstration projects to cut costs generated considerable discussion.

Cardiology is the trend: Hospital employee route or private practice?

January 31, 2012 |

As a leader in specialty procedures, cardiology is a growing field that is in demand from patients, as well as from hospitals looking to acquire practices. While some cardiologists are interested in being employed by hospitals, about 67% others prefer the private practice route.

Outpatient is in! 6 reasons why outpatient centers are growing

January 10, 2012 |

Healthcare is costly, especially on an inpatient basis, which is why it is not surprising that an established and growing trend has been the development of outpatient centers.

CMS hospital outpatient panel announces initial 2012 meeting

December 20, 2011 |

Richard Pizzi

The re-named Advisory Panel on Hospital Outpatient Payments, or HOP, will hold its first semi-annual meeting for 2012 Feb. 27-29, the Centers for Medicare & Medicaid Services announced last week.

Four ways to improve hospital revenue

December 19, 2011 |

Joel French

Most hospitals seek to improve revenue, but are challenged by static or declining patient volumes, reimbursement rate reductions and patient case reclassifications to comply with CMS regulatory requirements.

Testing healthcare changes ahead of time, smart move

December 14, 2011 |

Kester Freeman

To understand the value of Medicare demonstration projects you should take a look at a recent article from American Medical News.

CMS issues final rule for use of Medicare claims data for performance measurement

December 6, 2011 |

Richard Pizzi

The Centers for Medicare & Medicaid Services issued a final rule Monday for the release and use of Medicare claims data to qualified entities to measure the performance of Medicare providers under the Patient Protection and Affordable Care Act.

McKesson launches episode management solution to promote bundled payments and value-based reimbursement

October 18, 2011 |

McKesson has introduced McKesson Episode Management™, a software solution that supports the shift toward value-based reimbursement models by automating complex bundled payment programs of all sizes. Using a single, “bundled” payment for all services delivered in treating an episode of care — such as a total knee replacement — is emerging as one of the more promising healthcare reform initiatives because it moves payers and providers from a volume-based system to one that is based on best practices and value.

Compensation increases point to optimism at health insurers, despite weak economy

September 23, 2011 |

Payers are holding their compensation ground for 2011 as the reimbursement system for the insurance industry remains in a state of transition, according to results from Hay Group’s 2011 Health Insurance Study released today. Median salary structure adjustments were consistent from 2010 to 2011 at 2.0 percent, which is the lowest level seen in more than 10 years; down from a high of 3.1 percent in 2001.

American College of Surgeons opposes MedPAC proposal

September 16, 2011 |

Yesterday, the Medicare Payment Advisory Commission (MedPAC) reviewed draft recommendations related to the flawed and unsustainable Medicare Physician Payment system. The American College of Surgeons (ACS) is pleased that the MedPAC has recognized the need to eliminate the Sustainable Growth Rate (SGR) and move towards a reimbursement system that is based on quality of care. Unfortunately, while the MedPAC recommendations being considered do eliminate the SGR, they fail to meet the goal of quality and further jeopardize access to care. The recommendations do not value the role all physicians have in the continuum of care and would have a devastating impact on access to surgical care. Therefore, the American College of Surgeons (ACS) is strongly opposed to this proposal, which specifically includes a 5.9 percent cut for most physicians each year for three years.

Expeditive adds new service line, remote Medicare billers to Critical Access Hospitals

August 26, 2011 |

Expeditive, a leading provider of interim revenue cycle staffing and A/R SWAT teams has announced a new service line. It will provide remote Medicare Billing Specialists to Critical Access Hospitals.

TransUnion “Pulse Poll” reveals untapped opportunity in hospital point-of-service collections

August 17, 2011 |

According to a recent TransUnion Healthcare “pulse poll” distributed to more than 300 attendees of the Healthcare Financial Management Association’s (HFMA) Annual National Institute (ANI) conference, lack of preparedness and awareness on both sides of the payment equation are causing major challenges for point-of-service collections efforts.

MBC has large network of medical billers and coders

August 17, 2011 |

Family practice, inevitably the most prominent healthcare specialty, is growing at a substantial rate in the US along with increase in the number of patients, with Texas, Florida and California amongst the top five states when it comes to Family practice physicians in the US.

Keynote speakers, pre- and post-conference programs announced for 2011 HBMA Fall Annual Conference

August 16, 2011 |

The Healthcare Billing & Management Association (HBMA), a non-profit educational resource and advocacy group representing third-party medical billers and billing professionals, announced today the opening and closing keynote sessions for the association’s 2011 Annual Fall Conference.

MedeAnalytics report details Medicare-related “Perfect Storm” about to hit hospitals

August 15, 2011 |

The combination of multiple factors—Affordable Care Act (ACA)-mandated reductions, likely cuts to Medicare as a result of the recent debt ceiling legislation, the rise of risk-based reimbursement, and pressure from commercial payers—all portend a formidable, decade-long “perfect storm” for hospital finances, according to a comprehensive analysis released today by MedeAnalytics, a leading provider of healthcare performance management solutions.

CGI awarded Ohio Medicaid Recovery Audit Contractor (RAC) program

August 9, 2011 |

CGI Group Inc., a leading provider of information technology and business process services, today announced it has received a contract award for Medicaid Recovery Audit Contractor (RAC) program services for the Ohio Department of Job and Family Services (ODJFS) which supports the department's identification, correction, and prevention of improper Medicaid payments.

MedeAnalytics says debt-ceiling law could reduce Medicare payments to hospitals

August 5, 2011 |

MedeAnalytics, a leading provider of healthcare performance management solutions, today released an estimate of the impact on Medicare payments to hospitals by recently enacted debt-ceiling legislation.

Revenue Cycle Inc. forges partnership with D3 Oncology Solutions

August 5, 2011 |

Revenue Cycle Inc. announces that it has forged a strategic collaboration with D3 Oncology Solutions for SABRE financial consulting and support.

ProMedica St. Luke's Hospital implements Stockell Healthcare's InsightCS Revenue Cycle Information System

August 3, 2011 |