Lower reimbursement rates, denials behind razor-thin margins
- Hospitals and health systems are operating on razor-thin margins as reimbursement rates and denials create financial woes, a new survey indicates. The survey conducted by the Healthcare Financial Management Association (HFMA) and Eliciting Insights polled over 130 health system CFOs to identify major pain points and 2026 budget and labor...
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Understanding the Value-Based Reimbursement Model Landscape
The Centers for Medicare and Medicaid Services (CMS) aims to have all traditional Medicare beneficiaries under a value-based care model by 2030. Although the pace may be slow, the healthcare industry is shifting away from fee-for-service...Medicare Advantage Denials Jump 56%, Commercial Denials 20%
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...Surprise Billing Proposals Aim to Streamline IDR Process
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
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...Claims Reimbursement Speed, Denial Rate Tied to Location
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,...Claim Denials Pose Expensive Problem for Providers
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...AMA 2024 CPT Code Set Addresses Language Barriers, Immunization Codes
The American Medical Association (AMA) has released the 2024 Current Procedural Terminology (CPT) code set, which addresses language barriers by including Spanish descriptors of medical services. Each...CMS Reduces No Surprises Act Fee After Court Vacates Price Hike
CMS has reinstated the $50 fee for initiating a payment dispute under the No Surprises Act following a court ruling striking down a price hike earlier this year. The non-refundable administrative fee...What Payment Integrity Means for Providers, How to Avoid Claim Issues
Healthcare providers are constantly running into payment integrity tools payers put in place to ensure proper payment. But payment integrity is also crucial for providers if they want accurate, complete, and timely reimbursement. Of the...CMS Proposes 1.6% Payment Increase for ESRD Facilities
CMS has released a proposed rule for the end-stage renal disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2024. The...Back to the Basics, Other Payment Integrity Strategies Post-PHE
After an unprecedented three years, it’s time to return to the basics, according to Jordan Kearney, partner at Hooper, Lundy, and Bookman and founder of the firm’s Medicare Audits and Appeals Practice Group. By that, she means...CMS Announces Start Date for IRF Claims Review Demo
Inpatient rehabilitation facilities (IRFs) will have their Medicare claims reviewed either before or after payment as part of a demonstration CMS intends to take nationwide. CMS recently announced on...Independent Dispute Resolution Case Load 14X More Than Expected
Nearly a year after the federal government launched the independent dispute resolution (IDR) process under the No Surprises Act, over 330,000 balance billing disputes have been filed, nearly 14 times...Lawmakers Want to Tie Physician Payment Updates to Inflation
Several lawmakers are seeking to tie physician payment updates in Medicare to inflation to prevent potential physician shortage issues. Representatives Raul Ruiz, MD (D-CA-25), Larry Bucshon, MD...Proposed Rule to Boost Medicare Inpatient Rehab Payments by 3%
A new proposed rule from CMS would increase payments to inpatient rehabilitation facilities (IRFs) by $335 million next fiscal year. The draft regulation would also update quality reporting and new...AHA, AHIP Urge Supreme Court to Uphold False Claims Act Ruling
The American Hospital Association (AHA) and AHIP have filed an amicus brief challenging the federal government’s interpretation of the False Claims Act, stating that it would adversely impact...Sponsored by Brault Practice Solutions