Reimbursement News

Hospital payment cap slashes prices in Ore.

March 14, 2024 - An effort to reduce healthcare spending in Oregon has successfully lowered hospital prices and variation, according to a recent study in Health Affairs. Oregon implemented a cap on hospital prices in October 2019 and January 2020, when it applied the cap to members of the state’s employee health insurance plan. The policy capped hospital...


Articles

$460B spending bill averts shutdown, some physician pay cuts

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Congress narrowly avoided a partial government shutdown, sending a $460 billion spending bill to the President’s desk over the weekend. The bipartisan deal, passed by the House 339-85 last...

Hospital Groups Rally Against HHS’ Interpretation of DSH Payments Formula

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The American Hospital Association (AHA) and five other hospital groups are calling on the Supreme Court to challenge the Department of Health and Human Services’ (HHS) interpretation of...

Understanding the Basics of Bundled Payments in Healthcare

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The shift to value-based care has driven public and private payers to redesign reimbursement models that stress accountability for care quality and healthcare costs. As the fee-for-service environment...

House Bill Addresses Price Transparency, Site-Neutral Payment Policies

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The US House of Representatives has passed a bill to improve healthcare price transparency and establish site-neutral payment policies for drug administration. The Lower Costs, More Transparency Act...

Providers See Fourfold Increase in External Payer Audits

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2023 has been a big year for healthcare revenue integrity, with teams managing about four times more external payer audits in the last year. The finding from the latest “MDaudit Annual Benchmark...

How Many Medicare Part D Claims Are Subject to 340B Discounts?

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The share of Medicare Part D claims eligible for discounts in the 340B drug pricing program increased from 1.7 percent to 9.6 percent between 2013 and 2020, a study published in JAMA Health Forum...

Medicare Advantage Denials Jump 56%, Commercial Denials 20%

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Hospitals and health systems have seen a significant spike in claim denials as Medicare Advantage and commercial payers deny more of their reimbursement. A new analysis of data from over 1,300...

How Did Commercial Payments for COVID-19 Inpatient Stays Vary in 2020?

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Commercial payments for inpatient stays associated with COVID-19 in 2020 were higher for health system-affiliated and high-quality hospitals, a study published in JAMA Health Forum found. When the...

Surprise Billing Proposals Aim to Streamline IDR Process

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The Biden-Harris Administration has released a proposed rule to improve the independent dispute resolution (IDR) process for surprise billing by addressing payer-provider communication and adjusting...

Patient Access, Registration Errors Lead to Most Claim Denials

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Hospitals and health systems are facing more claim denials as front-end revenue cycle processes lead to errors. A recent survey conducted by the Healthcare Financial Management Association’s...

Reducing Barriers to MIPS, Advanced APMs Could Promote Participation

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Reducing barriers to Advanced Alternative Payment Model (APM) participation for physicians in rural areas could help promote value-based care and control rising Medicare spending, according to research...

Physician-Owned Hospitals Could Save Medicare Over $1B

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Physician-owned hospitals treated some of the most expensive Medicare beneficiaries at lower costs compared to traditional hospitals despite seeing similar patient populations, according to a recent...

Lower Payment Rates May Help Curb Medicare Spending on Post-Acute Care

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As Medicare Part A is expected to become insolvent by 2033, Congress should reduce Medicare spending on post-acute care by lowering payment rates to skilled nursing facilities (SNFs), home healthcare...

Gender Pay Disparities in Medicare Reimbursement Impact Neurosurgeons

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Gender pay disparities persisted for neurosurgeons between 2013 and 2020, with women receiving 44 percent less in annual payments than men, a study published in JAMA Surgery revealed. Researchers used...

MGMA: Sustainable Financing Needed to Protect Rural Healthcare

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Physician and facility reimbursement for rural practices is not sustainable and is impacting patient access to rural healthcare, the Medical Group Management Association (MGMA) tells Congress in a new...

62% of Hospitals Don’t Automate Any Part of Denials Management

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Most hospitals and health systems are not automating any component of denials management, according to a recent survey of healthcare finance and revenue cycle leaders. Commissioned by technology...

Claims Reimbursement Speed, Denial Rate Tied to Location

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Does your practice experience claims reimbursement delays? That may be because of where your practice operates, according to a recent analysis of financial transaction data. The new Crowe report,...

Firm Selection, Rollout Key Considerations of Revenue Cycle Outsourcing

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Firm selection, contracting, and rollout are among the top considerations shared by providers who recently outsourced revenue cycle management, according to a recent KLAS report. The KLAS report,...

Claim Denials Pose Expensive Problem for Providers

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Claim denials are posing a serious and expensive problem for healthcare revenue cycle management (RCM), according to a recent survey of healthcare leaders. A survey conducted by Plutus Health...