Reimbursement

Reimbursement

Who’s really responsible for unplanned hospital readmissions?

Jul 13 | Jeff Lagasse

Hospitals vs. outpatient clinics: Who causes more unplanned patient readmissions?

New research found that the length of time after which a patient returns to the hospital reveals a lot about…

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Bright Health’s payvider model sees triple growth

Jul 12 | Susan Morse

Bright Health's integrated payer provider model sees triple growth

The insurer is expanding its narrow network into new markets by 2019, CEO Bob Sheehy says.

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Jul 11 | Susan Morse

CMS cuts Affordable Care Act Navigator funding from $36 to $10 million

This year Navigator organizations will be judged on offering options to the ACA such as Association and short-term…

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CMS proposes to prevent Medicaid payments diversion

Jul 10 | Susan Morse

CMS proposes rule to prevent Medicaid payments from being diverted away from primary provider

The Centers for Medicare and Medicaid Services said the change is intended to ensure that…

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Jul 10 | Jeff Lagasse

Commercial health plans show widespread variation in coverage and reimbursement for speciality drugs

Less than half, 48 percent, of all drug coverage decisions are consistent across the…

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Trump Administration’s move to freeze $10.4B in risk adjustment payments disrupts markets

Jul 09 | Susan Morse

Trump Administration's freeze on $10.4 billion in risk adjustment payments disrupts markets

AHIP, CMS Administrator Seema Verma both say they want quick resolution to conflicting court…

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Missouri mandates managed Medicaid or payment cut

Jul 06 | Susan Morse

Missouri tells providers to use managed Medicaid or face a 10% payment cut

State wants hospitals in-network with Centene, UnitedHealthcare and WellCare but with no apparent savings.

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Jul 05 | Susan Morse

CMS gives providers another week to decide whether to jump into BPCI Advanced

The appeal of Bundled Payments for Care Improvement Advanced is in it qualifying as an advanced APM but concerns…

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What telehealth needs is a better definition

Jul 05 | Jeff Lagasse

Telehealth needs clearer definition amid regulatory inconsistencies, expert says

Since not all telehealth tools are created equal and the role of certain technologies remains vague, the time…

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Jun 29 | Jeff Lagasse

CMS policy to reduce hospital-acquired conditions had minimal impact, research shows

The targeted billing codes were rarely used by hospitals, far less than expected based on national…

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Featured Resources

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?

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.

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Montefiore hits 300% ROI with social determinants of health

List: 769 hospitals fined for medical errors, infections

Medicaid innovators tackle social determinants

Atul Gawande to lead Amazon, Berkshire Hathaway and JPMorgan Chase venture

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. ...

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.

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.

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 ...

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.

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 ...

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