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
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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
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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
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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
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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
News
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
Blog
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
Blog
Hospitals can take a deep breath, and rest easier for at least six months. CMS is delaying enforcement of its "two-midnight" policy until after Sept. 30.
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Post date: February 4, 2014
Blog
The Congressional Budget Office has raised the specter that reform to the Medicare physician fee schedule statutory update formula could increase the likelihood that the ACA's Independent Payment Advisory Board mechanism would be triggered potentially resulting in as much as $0.6 billion in Medicare provider cuts.
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Post date: January 30, 2014
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Yesterday the American Hospital Association, four regional hospital associations and four health systems launched a federal court challenge to the controversial two-midnight inpatient admissions policy established by the Centers for Medicare & Medicaid Services.
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Post date: January 23, 2014
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With the growing complexity and unpredictability of reimbursement, the existing back-end model of managing patients' payments is no longer sufficient. Hospital executives must focus on a proactive approach to collecting payment upfront as well as improving patient education.
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Post date: January 15, 2014
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This week, CMS released a proposed rule that would make significant revisions to the Medicare Advantage and Part D prescription drug program regulations. The agency estimates that the rule changes would reduce Medicare spending by $1.3 billion between 2015 and 2019.
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Post date: January 14, 2014
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While certain key generic drugs will take billions in drug costs out of the healthcare system in the next 3 to 4 years, this anticipated decline in spending is masking the growth of specialty drug costs.
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Post date: January 9, 2014
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Since the passage of the Affordable Care Act, there’s been an industry focus on accountable care organizations. This movement towards ACOs has major market implications for providers that are considering joining the Medicare Shared Savings Program for the January 2015 start date.
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Post date: January 6, 2014
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In late December, President Obama signed into law the Bipartisan Budget Act of 2013, which includes the Pathway for SGR Reform Act of 2013. While SGR drew most of the media attention, the Act includes a number of other provisions impacting the Medicare and Medicaid programs.
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Post date: December 31, 2013
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