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

Healthcare Payments

Efficient Hospitals Face Negative Medicare Margins, MedPAC Finds

March 18, 2019 - Medicare reimbursement rates rarely cover the actual costs of providing hospital care. But now negative Medicare margins are impacting the most efficient hospitals out there, according to a new report from the Medicare Payment Advisory Commission (MedPAC). In the commission’s annual March report to Congress, MedPAC reported that the select group of hospitals providing relatively...


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Addressing Healthcare Consumerism a Top Priority for Docs in 2019

by Jacqueline LaPointe

2019 will be the year of healthcare consumerism, according to industry experts. As patient financial responsibility increases, revenue cycle and finance leaders are finding it high time to align their business practices with...

17% of Families Make at Least One Large Healthcare Payment a Year

by Jacqueline LaPointe

One in six families make at least one extraordinary healthcare payment of at least $400 and one percent of annual income in any given year, researchers from the JPMorgan Chase Institute recently reported. Their findings, recently...

Healthcare Dollars Moving to Alternative Payment Models, LAN Finds

by Jacqueline LaPointe

Approximately 34 percent of all healthcare payments made in 2017 were tied to an alternative payment model (APM) with shared savings, shared risk, bundled payments, or population-based payments, according to a new report from the Health...

Auditors Recouped $214M in Medicare Improper Payments in 2016

by Jacqueline LaPointe

Recovery Audit Contractors (RACs) returned significantly more Medicare improper payments to the program’s trust fund during the 2016 fiscal year (FY), a recent CMS report to Congress shows. In FY 2016, the Medicare auditors returned...

Artificial Intelligence Ensures Payer, Provider Pay Covers Costs

by Jacqueline LaPointe

Artificial intelligence (AI) in healthcare is influencing the next generation of radiology tools and helping to expand access to care in underserved or developing areas. The technology is supporting clinical advancements, but a...

Industry Orgs Fight Anthem’s Emergency Department Payment Policy

by Jacqueline LaPointe

The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) are suing Anthem’s Blue Cross Blue Shield (BCBS) of Georgia over a new policy that allows the payer to retroactively deny emergency...

Hospital Revenue from Patient Financial Responsibility Up 88%

by Jacqueline LaPointe

Total hospital revenue attributable to patient financial responsibility after insurance increased 88 percent between 2012 and 2017, a new TransUnion Healthcare analysis uncovered. The growth in hospital revenue stemming from patient...

Half of PCPs Aware of Medicare Reimbursement for Chronic Care Mgmt

by Jacqueline LaPointe

CMS recognized that chronic disease management is key to lowering healthcare costs and improving patient outcomes by creating a Medicare reimbursement code for chronic care management. However, provider knowledge of the payment is...

Healthcare Orgs Still Rely on Paper-Based Medical Billing

by Jacqueline LaPointe

A new survey from Waystar and HIMSS Analytics shows that patients and providers are not seeing eye to eye when it comes to medical billing and collecting patient financial responsibility. The survey of almost 900 financial executives from...

AMA, ASAM Create Alternative Payment Model for Opioid Use Disorder

by Jacqueline LaPointe

The American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) recently unveiled an alternative payment model that aims to improve care and reduce costs associated with opioid use disorder. The new...

CMS Appeals Ruling on Changing Medicaid DSH Payment Rules in MO

by Jacqueline LaPointe

CMS is appealing a recent federal court decision that barred the agency from enforcing a 2017 final rule and two sub-regulatory articles from 2010 in Missouri. The federal agency stated that rule and articles clarified the formula for...

Price Transparency Crucial to Healthcare Consumerism Success

by Jacqueline LaPointe

Providers should brace their practices for the rise and permanence of healthcare consumerism, a new brief from Rice University’s Baker Institute for Public Policy stated. Healthcare consumers are expecting their experiences with...

Prices, Administrative Costs Drive Higher US Healthcare Spending

by Jacqueline LaPointe

High prices for provider compensation, healthcare services, and prescription drugs, as well as administrative costs, are responsible for increased healthcare spending in the US compared to other high-income countries, a new JAMA study...

Patient Financial Responsibility Increased 11% in 2017

by Jacqueline LaPointe

Patient financial responsibility is on the rise, according to findings from a TransUnion Healthcare analysis revealed at HIMSS18. Patients saw their average out-of-pocket costs increase 11 percent in 2017, growing from $1,630 in the fourth...

Addressing Regulatory Burden, Patient Payments Top HIMSS18 Trends

by Jacqueline LaPointe

Healthcare finance professionals can bet on discussing compliance, innovative health IT systems, and patient financial responsibility at the 2018 HIMSS Annual Conference and Exhibition (HIMSS18) in Las Vegas. Over 45,000 healthcare...

How the Bipartisan Budget Act of 2018 Impacts Claims Reimbursement

by Jacqueline LaPointe

After facing two government shutdowns this year, Congress passed a long-term budget deal and President Trump signed it into law early on Feb. 9, 2018. While the Bipartisan Budget Act of 2018 included plans for avoiding another shutdown and...

Consolidated Medical Billing Boosts Collections for a TX Group

by Jacqueline LaPointe

Providing a unified medical billing experience was key to improving patient collections by 24 percent in one year at the largest independent multi-specialty physician group in Abilene, Texas. Abilene Diagnostic Clinic boasts 30 physicians...

74% of Younger Patients Underpay Patient Financial Responsibility

by Jacqueline LaPointe

Nearly three-quarters of younger individuals did not pay their patient financial responsibility in full in 2016, a recent Transunion survey found. Millennials, or individuals between 23 and 37 years old, were significantly less likely to...

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