Reimbursement News

Complex COVID-19 Hospitalizations Cost an Average of $300K

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COVID-19 hospitalizations can cost up to $318,000, according to new cost estimates from FAIR Health. The FAIR Health Total Treatment Cost COVID-19 benchmarks account for the costs incurred by COVID-19...

Financial Incentives for Medical Assistants May Improve Care Delivery

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Financial incentives for medical assistants have the potential to increase their motivation at work and improve the quality of the care they provide, according to a study in The Annals of Medicine....

High Healthcare Spending Shifts to Uninsured, Prescription Drugs

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In nearly two decades, the overall concentration of healthcare spending has remained steady, but there has been an increase in the concentration of prescription drug spending, according to a study in...

Employers to Leverage Hospital Price Transparency to Lower Rates

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A new report shows the employers will use payer-specific negotiated rates exposed by hospital price transparency requirements to extract lower reimbursement rates from providers in their...

Medical Coding Slip at TX Hospital Led to COVID-19 Billing Error

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Midland Memorial Hospital agreed to pay over $555,000 for a medical coding error that resulted in claims being sent out for reimbursement from the government even though patients did not have a primary...

The Impact the Unvaccinated Are Having on Healthcare Spending

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The impact the unvaccinated population is having on healthcare spending is significant, according to a new analysis from Kaiser Family Foundation (KFF). There were approximately 287,000 preventable...

CMS to Start Reprocessing Site-Neutral Outpatient Claims

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CMS will begin to reprocess claims for outpatient clinic visit services provided at excepted off-campus provider-based departments, following a reinstated site-neutral payment policy. The agency will...

Revenue-Based COVID-19 Funds Failed to Help Some Hospitals in Need

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Congress allocated $178 billion to the Provider Relief Fund to help hospitals overcome the financial and operational challenges of the COVID-19 pandemic. But the primary distribution method for the aid...

Hospitals Still Waiting on Remaining COVID-19 Provider Relief Funds

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The American Hospital Association (AHA) is urging HHS to distribute billions of dollars still sitting in the COVID-19 Provider Relief Fund. The Sept. 2 special bulletin from the AHA said that it...

2022 CPT Code Set Released, Streamlines Medical Coding for COVID-19

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The new 2022 Current Procedural Terminology (CPT) code set aims to streamline medical coding and documentation of COVID-19 vaccinations, among other updates. The code set released today by the...

AMA Updates CPT Codes for COVID-19 Vaccines

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The American Medical Association (AMA) has announced updates to the Current Procedural Terminology (CPT) code set to account for changes to COVID-19 vaccines, including booster shots expected to...

How Has COVID-19 Impacted Medicare Spending, Solvency?

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The Medicare Trust Fund is still expected to run out by 2026 despite increased Medicare spending on COVID-19 treatment and prevention over the past year and a half, a new report reveals. The annual...

AMGA Pushes Congress to Prevent 10% Medicare Payment Cut

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Medical groups are urging Congress to prevent significant cuts to Medicare payment that could be triggered by recent spending bills and a proposed rule from CMS. In a letter to Congressional leaders,...

Risk-Based Revenue Stalls Despite Challenges with Fee-For-Service

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Most hospitals suffered heavy financial losses during the COVID-19 pandemic as a direct result of the fee-for-service payment system, yet progress toward a more stable, risk-based revenue structure...

COVID-19 Workflows Improve Medical Coding Efficiency Beyond Pandemic

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Getting shots into arms has been a top priority for healthcare providers since the federal government gave the green light to several COVID-19 vaccines. But while speed was key for immunizers, medical...

NYT Slams Hospital Price Variation After Price Transparency Rule

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Hospital price variation is widespread and much more noticeable now that CMS has enforced a price transparency rule, according to a recent report published in The New York Times. The national news...

OIG: Medicare Overpays for Chronic Care Management Services

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An Office of the Inspector General (OIG) audit discovered that Medicare consistently overpaid for chronic care management (CCM) services, incurring millions in costs for Medicare and its...

Medicare Reimbursement Available for Third Dose of COVID-19 Vaccine

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Now that the Food and Drug Administration (FDA) has authorized a third dose of COVID-19 vaccines for immunocompromised people, CMS said it will provide Medicare reimbursement for immunizers. A CMS...

Telehealth Claim Lines Stabilize After Months of Decline

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The percentage of telehealth claim lines has stabilized at about 5 percent of medical claim lines, indicating a new balance of virtual and in-person care. The analysis conducted by FAIR Health as part...

GAO Pushes HHS to Reveal Plans for Unused Provider Relief Funds

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The Government Accountability Office (GAO) is recommending that HHS communicate information of the department’s plans for unused Provider Relief Fund money. A report released publicly on July...