Claims Reimbursement

Adjusting Medicaid Payments for Social Determinants to Boost Care

by Samantha McGrail

Adjusting Medicaid payments for social determinants of health would help address the broader social needs of children and cost restraints at safety-net hospitals, according to researchers from the...

Site-of-Service Medicare Reimbursement Led to More Hospital Testing

by Jacqueline LaPointe

When Medicare reimbursement depended on location, greater hospital-based versus practice-based payments were associated with higher proportions of outpatient non-invasive cardiac tests performed in the...

HHS Ahead of Schedule for Eliminating Medicare Appeals Backlog

by Jacqueline LaPointe

HHS reduced the Medicare appeals backlog at the administrative law judge level by 25 percent through the third quarter of fiscal year (FY) 2019, according to a recent status report obtained by the...

Hospitals Retain 91% of Profit from Physician-Administered Drugs

by Jacqueline LaPointe

Physician practices and hospital outpatient clinics treat a similar number of commercially insured patients needing physician-administered drugs, but hospitals receive a larger share of the gross...

Despite Financial Incentives, Medical Imaging Rates Reaccelerating

by Jacqueline LaPointe

Reducing reimbursement rates and implementing broad campaigns among physician groups has done little to decelerate medical imaging rates, suggested a study recently published in the Journal of the...

How Healthcare Price Transparency Can Cuts Costs, Improve Value

by Jacqueline LaPointe

Market-wide healthcare price transparency is a key way to increase the value of healthcare spending, according to a new study from the Harvard T. H. Chan School of Public Health. Published in the...

6 Challenges of End-to-End Automation for Prior Authorizations

by Jacqueline LaPointe

Only 12 percent of the 182 million medical sector prior authorization transactions were fully electronic in 2018, making prior authorizations one of the most manual transactions compared to other...

CMS Addresses Antibiotic Resistance with IPPS Medicare Payments

by Jacqueline LaPointe

The FY 2020 IPPS final rule included a slew of Medicare payment updates, including a 3.1 percent boost in hospital reimbursement and a new hospital wage index system. But also contained within the...

Medicaid DSH Payments Cover 51% of Uncompensated Care Costs

by Jacqueline LaPointe

Medicaid Disproportionate Share Hospital (DSH) payments covered about half of the uncompensated care costs incurred by qualifying hospitals nationwide in 2014, according to a Government Accountability...

HHS Reduced Medicare Appeals Backlog by 19% Since Fall 2018

by Jacqueline LaPointe

HHS has made significant progress with reducing the Medicare appeals backlog, decreasing the number of appeals pending at the Office of Medicare Hearings and Appeals (OMHA) by about 19 percent as of...

Bill Ending Surprise Medical Billing Would Save $7.6B by 2029

by Jacqueline LaPointe

Legislation that would end surprise medical billing would save nearly $7.6 billion over the next decade primarily by reducing federal subsidies for healthcare and insurance, the Congressional Budget...

Home Infusion Benefit, 1.3% Payment Boost in Home Health PPS Plan

by Jacqueline LaPointe

CMS is considering a number of changes to the home health prospective payment system (PPS) in CY 2020 and 2021, including making the home infusion benefit permanent and further implementing a new...

Greater Volumes, Consolidation Likely Under Medicare for All

by Jacqueline LaPointe

Medicare for All would certainly reduce healthcare spending through lower physician revenue. But the policy could also have unintended negative consequences, such as increasing the volume of expensive...

Hospitals Face New TAVR Volume Rules for Medicare Reimbursement

by Jacqueline LaPointe

CMS recently finalized an update to the Medicare reimbursement policy for transcatheter aortic valve replacement (TAVR), a minimally invasive procedure to replace a narrowed aortic valve does not open...

MedPAC Suggests Elimination of Incident To Billing for APRNs, PAs

by Jacqueline LaPointe

CMS should do away with “incident to” billing for advanced practice registered nurses (APRNs) and physician assistants (PAs) and pursue a stay-based payment design when implementing a...

How Advocate Aurora Health Streamlined Prior Authorizations

by Jacqueline LaPointe

Prior authorizations used to be one of the greatest pain points for providers at Advocate Aurora Health. While most physicians recently surveyed by the American Medical Association (AMA) said they...

Supreme Court Rules Against HHS in Medicare DSH Payment Case

by Jacqueline LaPointe

In a 7-1 decision released on Monday, the Supreme Court sided with hospitals that sued HHS in 2014 over a change in how the department calculated Medicare disproportionate share hospital (DSH)...

Using Artificial Intelligence to Advance Revenue Cycle Management

by Jacqueline LaPointe

Artificial intelligence (AI) is making big waves in healthcare from detecting lung cancer and gene mutations that lead to autism to addressing social determinants of health and chronic conditions. The...

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