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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Healthcare Finance News talked to Kevin Brennan, Geisinger's executive vice president and CFO, about the advantages the health system has seen by adopting the bundled payment model.
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Post date: January 17, 2014
News
Empowered consumers, rapid innovation and increasing competition are among PwC's top health industry issues for 2014.
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Post date: January 16, 2014
News
Reimbursing a physician for their time spent in having end-of-life discussions is not an incentive for a "death panel" decision; it would be compensating them for doing their job. If all we do is compensate physicians for treating people aggressively regardless of the circumstances, we will get what we pay for: an expensive healthcare system run amok.
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Post date: January 15, 2014
News
In a reversal of 30 years' past practice, Medicare may start to disclose what it pays individual physicians for its services to seniors.
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Post date: January 14, 2014
News
Hospitals in the state of Maine are bracing for an uncertain future in 2014. Maine is one of 23 states not planning on expanding Medicaid this year.
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Post date: January 10, 2014
News
Maryland officials have reached what analysts say is an unprecedented deal to limit medical spending and abandon decades of expensively paying hospitals for each extra procedure they perform. If the plan works, Maryland hospitals will be financially rewarded for keeping people out of the hospital.
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Post date: January 10, 2014
News
Across the U.S., hospital costs are rising while revenue and patient volume are falling. Rural not-for-profit hospitals, in particular, face a challenging financial future, one in which some facilities might close or at least "go hungry."
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Post date: January 9, 2014
News
An analysis of new Medicare data provides a look at how the nation's hospitals are doing with all-cause, unplanned readmissions.
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Post date: January 6, 2014
News
Hospitals and health systems will face ever more pressure in 2014 to establish the core skills needed to thrive in a rapidly changing healthcare market.
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Post date: January 6, 2014
News
The California Department of Managed Health Care is trying to end the practice of emergency care "balance billing," just as thousands of new HMO members are being created.
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Post date: December 31, 2013
News
The December issue of Healthcare Finance News highlights the biggest stories our staff covered across the previous 12 months. And as has been the case for much of the past decade, many of the top issues deal with the tremendous changes impacting the healthcare industry.
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Post date: December 30, 2013
News
All the talk about moving healthcare reimbursement from volume to value sounds great, in theory. But how this shift takes place in practice is more complex than simply ending one form of payment and starting a new one.
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Post date: December 27, 2013
News
Hospital emergency departments may begin receiving "considerably more" reimbursement once the Affordable Care Act is fully implemented, a new study claims, pleasing hospital CFOs as well as ER docs.
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Post date: October 29, 2013
Blog
A bipartisan group of House lawmakers has introduced a bill that would expand telemedicine coverage for Medicare and Medicaid patients, and adjust payments for certain telehealth services.
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Post date: October 28, 2013
Blog
The Centers for Medicare & Medicaid Services is currently assessing the impact of the partial government shutdown on the 2014 Medicare fee for service payment regulations, and intends to issue the final rules on or before November 27, 2013.
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Post date: October 24, 2013
Blog
While estimating the cost of an ICD-10 transition may be scary, medical practices should perhaps be more worried about what could happen to revenue.
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Post date: October 23, 2013
Blog
The healthcare system has been pretty much a business-to-business sector, but from October, two big things change. Millions of unpredictable individuals enter the market as consumers, and the underlying risk calculation shifts from one that is largely clear and underwritten, to one that depends on a precarious balance.
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Post date: October 18, 2013
Blog
The ongoing partial federal government shutdown is having a varied impact on healthcare provider operations. Some have experienced the impact in the form of curtailed survey and certification activities.
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Post date: October 10, 2013
Blog
As health insurance exchange enrollment begins today, the stakes are high for states with large uninsured populations that are declining to expand Medicaid. That political decision could be the difference between the status quo and improvements in healthcare access and sustainability.
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Post date: October 1, 2013
Blog
CMS has announced a follow-up Special Open Door Forum conference call on Sept. 26 on the "two midnights" benchmark. It's intended to allow hospitals and other providers to ask questions on the FY14 physician order and physician certification, inpatient hospital admission and medical review criteria in the IPPS/LTCH final rule.
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Post date: September 24, 2013
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Perhaps the most front and center challenge facing healthcare providers today in preparing for the impact of the Affordable Care Act is in the area of reducing costs.
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Post date: September 23, 2013
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The Internal Revenue Service has issued final regulations to implement the ACA requirement that every individual have basic health insurance coverage, qualify for an exemption, or make a "shared responsibility" payment when filing a federal income tax return, beginning in 2014.
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Post date: September 20, 2013
Blog
As we get closer to 2014, consumers are being surrounded by news coverage, ads and opinions about the health law. And many of them are turning to their doctors for advice. The American Medical Association wants to help doctors with answers.
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Post date: September 16, 2013
Blog
Two-thirds of U.S. hospitals will receive payment reductions tied to Medicare readmission penalties to see that improving the level of care will be the foundation for building operational sustainability in the future.
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Post date: September 12, 2013
Blog