Reimbursement

Reimbursement

Sep 20 | Susan Morse

CMS: Innovative new payment models are coming -- and some will be mandatory

CMS has made it clear that it wants health systems to share the risk of cost and outcomes.

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Sep 19 | Jeff Lagasse

For-profit hospitals correlated with higher readmission rates, study finds

CMS levies reimbursement penalties against hospitals that underperform on 30-day readmission rates, leaving…

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Sep 18 | Susan Morse

Change Healthcare puts blockchain claims processing tech on Amazon Web Services

Payers and providers can track, in real time, the status of claims submissions and remittances.

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Sep 11 | Susan Morse

American Hospital Association suing HHS over delay in implementing drug pricing rule for 340B

AHA joins other 340B stakeholders in asking the court to declare the delay unlawful and to enact…

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Sep 11 | Susan Morse

MSSP ACOs saved more money than CMS reported, says National Association of ACOs

ACO MSSP generated savings of $1.84 billion from 2013 to 2015, nearly double the $954 million estimated by…

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Sep 10 | Susan Morse

ACA about-face: Insurers keeping premium increases lower than last year, RWJF and AP studies find

Two new reports find payers expanding their footprint in the Affordable Care Act marketplace…

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Sep 10 | Susan Morse

UnitedHealthcare wins court case over Medicare Advantage overpayment rule

Ruling throws out 2014 rule, leading to question of how CMS will determine whether it has overpaid an MA insurer.

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Sep 07 | Susan Morse

Montana health plan strikes victory over cost-sharing reduction payments

The insurer says it is owed $5 million in payments mandated under the Affordable Care Act.

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Sep 06 | Jeff Lagasse

Hospital resources strained as Medicare reimbursement for MRI-compatible cardiac devices lags

The total spend increase for CRM devices is 8 percent, which translates to a $400 million…

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Sep 06 | Susan Morse

Texas court case tests whether Affordable Care Act can survive without individual mandate

Judge to decide whether loss of individual mandate is tied to keeping essential benefits for those…

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Featured Resources

Beyond Dollars and Cents: A Closer Look At Value Beyond the expected improvement in specific metrics, many organizations that outsource RCM with a trusted and certified partner are seeing several ancillary benefits of such agreements.

Care Collaboration Success for Improved Outcomes The nature of our healthcare ecosystem has been one of siloed care. Rarely do payers, providers and local resources come together with the patient's well-being prioritized as a unifying mission. Read how these organizations are getting it right.

Debunk the Myth: Outsourcing Doesn't Mean Losing Control With shifts in payer mixes and reimbursement structure, the margin of reimbursement has been shrinking steadily over the last five years. How do revenue cycle leaders navigate payment reform while maintaining stable business office operations?

MostPopular

CMS nixes "excessively burdensome" Medicare requirements

Aetna, CVS Health need to divest Part D plans, DOJ says

CMS: New innovative payment models coming

Nurse practitioners ease physician shortage? Not so fast

News

Once-failing hospitals say accountability, transparency key to surviving fallout from failing patient safety grades When Leapfrog released their Spring 2016 patient safety grades recently, 15 hospitals got slapped with a very public 'F' grade casting a spotlight on them that no institution wants. ...

Analyze this: Health systems, health plans get to the core of big data Pamela Peele knows that people who subscribe to cooking magazines have a much higher risk of going to the emergency room. But how she knows that is a whole other story.

Healthcare mergers and acquisitions in 2016: Running list While 2015 was a record-breaking year in healthcare mergers and acquisitions, 2016 saw more change as organizations across the industry adjust and adapt to the evolving financial landscape.

Whitepapers

Clinical Quality Measures 101 Although quality-reporting programs such as meaningful use provide incentives to help providers implement and use electronic health records (EHRs) to collect and report on clinical data, practices often need help deciding what data to collect, which measures to report ...

Gaining Actionable Insight into Financial Systems and Areas Impacting the Revenue Cycle Hospital systems across the country are looking to streamline their billing and collection processes to become more efficient and better compete in their markets. The challenge many face is how to turn the data ...

Credible, Defensible Estimates In healthcare, every interaction with the patient matters. Especially in today’s environment of continuous improvement, efforts have been concentrated on coordination among providers, the patient care experience and quality outcomes – all laudable goals.

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