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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Insurers offering Medicare Advantage plans got a bit of a reprieve this week when the Centers for Medicare & Medicaid Services gave them a rate increase instead of the expected cut. CMS' 2015 rate announcement also addressed concerns over provider terminations and beneficiary cost sharing.
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Post date: April 9, 2014
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The House of Representatives passed a bill yesterday to forestall scheduled cuts to Medicare physician payments through April 1, 2015, to delay the ICD-10 implementation deadline for one year, and to suspend enforcement of the controversial two-midnight policy.
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Post date: March 28, 2014
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The House of Representatives passed a bill yesterday to forestall scheduled cuts to Medicare physician payments through April 1, 2015, to delay the ICD-10 implementation deadline for one year, and to suspend enforcement of the controversial two-midnight policy.
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Post date: March 28, 2014
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All but five states received a failing grade this year on the way they provide healthcare price transparency, according to a report by Catalyst for Payment Reform and the Health Care Incentives Improvement Institute.
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Post date: March 27, 2014
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With a new study showing both inpatient reductions and specialty care increases linked to high-risk medical home patients, health systems have more evidence to buy into the PCMH model as part of their clinical and financial improvement strategies.
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Post date: March 26, 2014
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An unusual 90-day grace period for government-subsidized health plans may leave physicians at risk for not getting paid for their services.
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Post date: March 20, 2014
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Hospitals are just beginning to catch on to the promise of integrated data analytics to manage patient population health and measure treatment outcomes. These benefits not only assist the transition toward patient-focused care, they're helping healthcare institutions reduce associated costs.
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Post date: March 13, 2014
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With several states weighing whether to expand Medicaid under the federal health law, supporters are looking to powerful business groups to help sway skeptical state legislators. But those groups are split on the issue -- just like the public at large.
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Post date: March 11, 2014
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Despite the hassle of auto-cancellations, many home healthcare agencies find it difficult to keep track of their requests for anticipated payment.
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Post date: March 11, 2014
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Some states have found practical success in establishing the Affordable Care Act, but what distinguishes their efforts are their unique fit within each state's distinctive political and business climates.
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Post date: March 10, 2014
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A new federal regulatory proposal to ensure adequate insurance networks could help not-for-profit hospitals, Moody's said in a briefing released this week.
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Post date: March 6, 2014
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In case anyone was wondering, the RACs haven't gone away for good. They're just taking a vacation. The Centers for Medicare & Medicaid Services announced a "pause" in RAC audits last month, in preparation for the procurement of the next round of RAC contracts.
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Post date: March 6, 2014
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Demand for endoscopic video systems is expected to grow as new techniques enable even more procedures to be performed in a minimally invasive manner. This will make the question for today’s hospital not if to purchase a system, but how many to purchase.
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Post date: March 18, 2014
Blog
Managing ambulatory care used to be about taking care of patients while managing your budget. Those days will have to change to stay competitive with the new payment model.
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Post date: March 18, 2014
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It has never been clearer: physician practices must be able to code in ICD-10 to bill for services and procedures after Oct. 1, 2014, or they will see a cash flow interruption, additional costs and delayed claims payments. But payers, clearinghouses and vendors can help you.
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Post date: March 11, 2014
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Take note, hospitals: the Centers for Medicare & Medicaid Services has recently announced modifications to the implementation of the controversial "2-Midnight" inpatient admissions policy, as well as releasing the preliminary federal disproportionate share hospital allotments for FY2014.
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Post date: March 4, 2014
Blog
The overall market for angiography services should remain stable in the near future. But one long term growth trend to keep watch on is the shift towards improving prevention based on early identification, reducing risk factors, education and early intervention if necessary.
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Post date: March 4, 2014
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There's still plenty of work to do before the Oct. 1 ICD-10 deadline. A recent study found that only 4.8 percent of physician practices reported significant progress in overall ICD-10 readiness. Hospitals report higher levels, but many are still behind.
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Post date: March 3, 2014
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In its third year as a Pioneer ACO, Montefiore Care Management has seen a 10 percent reduction in inpatient admissions, a 35 percent reduction in all-cause readmissions and a 45 percent reduction in diabetes inpatient admissions.
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Post date: February 24, 2014
Blog
Once an organization decides to transition to the accountable care model, there is an immediate need to begin long-term financial planning. While your organization is working to drive down costs, it must also look for ways to maintain profitability.
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Post date: February 14, 2014
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For the second time in two months, Congress has turned to an extension of Medicare sequestration as a funding mechanism -- a troubling new trend for Medicare providers.
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Post date: February 13, 2014
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National healthcare expenditures grew at an annual rate of 4.1 percent in 2013, according to an analysis by the Altarum Institute. This is the fifth consecutive year of spending growth in the 4 percent vicinity.
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Post date: February 12, 2014
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There is a common misconception in healthcare that nearly all value-based care models are one-of-a-kind. In truth, while the starting point may be unique for many organizations, value-based models are actually conceptually quite similar.
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Post date: February 7, 2014
Blog
As a healthcare consumer, am I most interested in short-term complications and readmission rates or am I interested in getting cured of whatever I have? The recent hullabaloo over narrow networks and whether a more expensive hospital is worth it or not seems to miss the bigger point.
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Post date: February 6, 2014
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