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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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
If we don't fundamentally change the way we pay for healthcare, we won't change the economic principles that continue to drive the rapid growth in healthcare spending. Let's pay physicians and hospitals based on the health problems their patients have.
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Post date: July 15, 2014
News
Cancer treatment costs are among the highest in the healthcare industry. Insurer UnitedHealthcare created a pilot in an attempt to lower costs that has yielded some promising, though somewhat mixed results.
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Post date: July 14, 2014
News
Blue Cross and Blue Shield companies are making progress in its transition from fee-for-service to value-based reimbursement models.
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Post date: July 14, 2014
News
The Affordable Care Act included a number of delivery system reforms, such as ACOs, bundled payments, and workforce provisions to strengthen foundations in primary care. Unfortunately, a focused effort on payments for specialists was not included.
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Post date: July 10, 2014
News
Medicare regulators are updating hospital outpatient and ambulatory surgery center payments for next year, and also outlining a potential remedy to private Medicare overpayments.
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Post date: July 10, 2014
News
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
Bariatric surgery has experienced a 16-fold growth in the U.S. within the last 15 years. Reimbursement for gastric band placement and gastric band removal/replacement -- the main types of bariatric procedures -- will increase by 4.5 percent and 6.8 percent respectively in 2014.
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Post date: June 4, 2014
Blog
For the first time in decades, cracks are appearing in the traditional fully insured model of healthcare coverage. The time is ripe for health systems to jump into the gap with an old approach delivered a new way -- direct contracting.
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Post date: June 3, 2014
Blog
Bundled payments represent a new and increasingly accepted form of reimbursement. They can work now, if applied in modest, manageable ways from which lessons can be learned and applied more broadly later.
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Post date: May 22, 2014
Blog
Value-based purchasing introduces the potential for unintended consequences, and needs to be monitored to avoid disparities between hospitals. But it's too early to claim that VBP puts disproportionate share hospitals at a disadvantage.
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Post date: May 19, 2014
Blog