Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Emergency Department

MedPAC Suggests Cutting Medicare Reimbursement for Stand-Alone EDs

April 9, 2018 - The Medicare Payment Advisory Commission (MedPAC) recently voted to reduce Medicare reimbursement by 30 percent for off-campus stand-alone emergency departments (ED) in urban areas. The recommendation will be included in the commission’s June 2018 report to Congress. MedPAC expressed concerns that stand-alone EDs in urban areas resulted in overutilization of emergency services. Between...


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Care Coordination, Community Health Workers Reduce ED Costs, Use

by Jacqueline Belliveau

Average direct emergency department costs dropped 15 percent for frequent emergency department users after Brigham and Women’s hospital implemented a care coordination program using community health workers, according to a recent study...

ED Spending Increases 85% As Hospitals Code for More Severe Cases

by Jacqueline Belliveau

Emergency department spending per member rose 85 percent between 2009 and 2015 primarily because of hospitals coding and billing for a greater number of high severity cases, new Health Care Cost Institute (HCCI) data revealed. Spending on high...

Does Where Freestanding EDs Operate Change Hospital Payer Mix?

by Jacqueline Belliveau

Freestanding emergency departments (EDs) may be altering the payer mix at the equivalent hospital-based facility because the freestanding EDs tend to be located in areas with greater household incomes and insured rates, stated a recent Health...

Out-of-Pocket Healthcare Spending Rose 65% at Freestanding EDs

by Jacqueline Belliveau

Freestanding emergency departments are becoming a popular alternative care setting for common conditions, such as upper respiratory infections. But a recent study in the Annals of Emergency Medicine found that median prices for out-of-pocketing...

Unexpected Patient Financial Responsibility in 20% of ED Cases

by Jacqueline Belliveau

Approximately 20 percent of hospital admissions stemming from an emergency department visit in 2014 led to unexpected patient financial responsibility in the form of surprise medical bills, a recent Health Affairs study reported. Using national...

How Emergency Providers Can Adopt Alternative Payment Models

by Jacqueline Belliveau

With many value-based care initiatives aiming to reduce costly emergency room visits, some emergency departments are finding it increasingly difficult to engage with alternative payment models, according to a report in the American Journal of...

Despite ACA, Emergency Department Visits Remain Numerous

by Catherine Sampson

Although policymakers want to see the Affordable Care Act (ACA) lead to a reduction in visits to emergency departments, new data from the Centers for Disease Control & Prevention (CDC) raise concerns about the mandate’s real impact...

3 Strategies to Innovatively Advance Emergency Care Delivery

by Jacqueline DiChiara

The simple concept of value is a missing piece of the emergency department (ED) care spectrum puzzle, according to key findings released within Press Ganey’s white paper survey of over 1 million patients. Through the execution of numerous...

End of Medicaid Fee Bump Could Impact Emergency Departments

by Ryan Mcaskill

The end of the Medicaid fee bump could cause an increase in inappropriate and costly emergency department usage. Last month, this blog covered news that the “fee bump” for Medicaid reimbursement would end on December 31, 2014. This...

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