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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With millions of Americans on new health insurance exchange plans now responsible for high deductibles, hospitals, drug makers, insurers and regulators are entering a new frontier of payment disputes.
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Post date: May 23, 2014
News
Hospital ownership of physician practices appears to lead to statistically and economically significant increases in hospital prices and spending, according to a recent study published in Health Affairs. But that doesn't mean providers should retreat from integration and tighter alignment.
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Post date: May 22, 2014
News
Medicare may be overpaying hospitals an estimated $5 billion as a result of the 18-month moratorium on enforcing the controversial two-midnight rule that tells hospitals when patients should be admitted, according to an independent Medicare auditing company.
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Post date: May 21, 2014
News
While majorities of healthcare providers see value-based payment models becoming the reimbursement status quo in coming years, fewer than one-in-three say the reward is worth the risk.
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Post date: May 20, 2014
News
If global spending becomes the norm in Medicaid, health systems, medical practices, home health and community organizations will face an even greater impetus to collaborate. In the Empire State, some are already starting the journey.
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Post date: May 19, 2014
News
Last week, the Centers for Medicare & Medicaid Services published a final rule that reforms federal health policy regulations that CMS has identified as unnecessary, obsolete, or excessively burdensome on healthcare providers and suppliers. Here are some highlights.
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Post date: May 19, 2014
News
According to a study published this week in Health Affairs, the Great Recession did not have a permanent negative financial impact on vulnerable hospitals, such as safety net facilities, or those considered financially weak prior to the recession. However, this doesn't mean these same hospitals will fare so well in coming years.
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Post date: May 16, 2014
News
An extension of presumptive eligibility coverage takes away Medicaid payment uncertainty if hospitals make the effort to participate and follow the rules.
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Post date: May 13, 2014
News
A new Medicare prospective payment system for federally qualified health centers offers improved reimbursement rates.
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Post date: May 12, 2014
News
Americans are paying higher prices for cancer drugs because more patients are being treated by oncologists whose practices have been bought by hospitals, which may charge double or more for the same treatments, according to a new report.
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Post date: May 7, 2014
News
Implementation of the Affordable Care Act is likely to lead to increased profitability for hospital emergency departments.
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Post date: May 7, 2014
News
Hospitals are educating their staff and reworking their processes to comply with Medicare's two-midnight rule, which will likely reduce hospital revenue by shifting patients from inpatient to outpatient status.
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Post date: April 29, 2014
News
In an effort to raise awareness of hospital price variation, the California Public Employees’ Retirement System and Anthem Blue Cross started a “reference pricing” initiative in 2011. It appears to be having an impact.
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Post date: December 9, 2013
Blog
Dual coding is probably the best idea to support the ICD-10 transition that many healthcare providers may not be able to afford. Here's why.
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Post date: December 5, 2013
Blog
Did you know that ultrasound, as a nonradiation modality, is expected to see an overall increase in reimbursement? Although there are some areas where threats of lower reimbursements are serious, overall, there will be incentives to utilize ultrasound where it is clinically warranted.
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Post date: December 4, 2013
Blog
Fee-for-service methodologies, especially relative-value units (RVUs), keep creeping back into alternative payment models like capitation. Maybe we should take the hint and adapt RVUs to the new environment rather than throwing them out the window.
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Post date: November 22, 2013
Blog
Earlier this year, the Centers for Medicare & Medicaid Services addressed several misunderstandings around ICD-10 in its "Myths and Facts" guide. While CMS debunked some of the most common ICD-10 myths, much of the industry is still confused about key topics.
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Post date: November 15, 2013
Blog
The dental industry is not commonly considered a source of “best practices” for general healthcare reimbursement, but dental practices employ a number of strategic approaches that can be leveraged by other providers.
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Post date: November 14, 2013
Blog
Hanging above physicians like the mythical sword of Damocles, the sustainable growth rate (SGR) provision threatens to impose a 24.4 percent decrease to the Medicare Physician Fee Schedule on Jan. 1, 2014.
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Post date: November 12, 2013
Blog
Reference pricing is a great cost-saving idea and I'd like to see more of it. But it’s a pretty poor argument for the superiority of the free market in healthcare.
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Post date: November 11, 2013
Blog
The Centers for Medicare & Medicaid Services has updated a handful of documents in the past week on the controversial regulations surrounding its two-midnight inpatient admissions guidance and patient status reviews.
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Post date: November 7, 2013
Blog
One of California's largest health systems is paying $46 million to settle allegations of overcharging payers with obscured anesthesia billing practices. The state's insurance commissioner calls the agreement "groundbreaking."
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Post date: November 5, 2013
Blog
By noting potential industry headwinds in credit rating agencies' median reports, hospitals can attempt to stay one step ahead of the ever-changing landscape when trying to navigate these difficult times.
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Post date: November 1, 2013
Blog
The Affordable Care Act cuts Medicare price growth. But if hospitals respond by increasing the amount of care provided, the potential cost savings from price restraint may be lost.
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Post date: October 31, 2013
Blog