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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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
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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
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Through its Medicare Care Choices Model, the Centers for Medicare & Medicaid Services is offering extra money to cover care management services, but not all hospices are jumping at the chance.
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Post date: July 10, 2014
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A new study says there's no need to worry about hospitals using their new electronic medical records to generate bigger bills and boost their income, but the study may not be checking the right data.
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Post date: July 9, 2014
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If your modus operandi is to appeal all denied claims, you may want to reconsider because some claims are not worth it.
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Post date: July 8, 2014
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The Centers for Medicare & Medicaid Services issued a proposed rule Tuesday that would reduce Medicare payments to home health agencies by $58 million next year and hinted at changes to come.
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Post date: July 2, 2014
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A patient-centered medical home program with a physician-owned, multispecialty group has been so promising that Aetna is extending the arrangement.
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Post date: July 2, 2014
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In an effort to survive and thrive in the transition to value-based payment models, New Jersey's Hackensack University Medical Center launched an experiment, which, so far, looks promising.
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Post date: June 27, 2014
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Ambulatory surgery centers have new evidence to back up arguments for its relative cost-effectiveness.
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Post date: June 26, 2014
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A quarter of the nation's hospitals in October will receive lower Medicare payments because their rates of patient complications are higher than their peers. Here is an explanation of the three measures Medicare is using to calculate the hospital-acquired conditions scores.
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Post date: June 24, 2014
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Many questions remain on how specific details of the Affordable Care Act will be resolved, but one significant trend is clear: the shift toward risk sharing among patients, providers and insurers is well underway.
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Post date: June 23, 2014
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A quarter of the nation's hospitals, those with the worst rates of hospital-acquired conditions, will lose 1 percent of every Medicare payment for a year starting in October. The sanctions, estimated to total $330 million over a year, kick in at a time when most infections measured in hospitals are on the decline, but still too common.
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Post date: June 23, 2014
News
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
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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
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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
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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
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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
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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
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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
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Twenty-four states, including almost the whole South, took the stubborn path and have so far refused to expand Medicaid. That's a big reason rural hospitals are continuing to struggle.
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Post date: May 13, 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
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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
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