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

Hospital Reimbursement

Are Hospital Readmissions Reduction Program Results Overstated?

January 10, 2019 - CMS, researchers, and other healthcare stakeholders have touted the Hospital Readmissions Reduction Program (HRRP) touted as a success. Under the authority of the Affordable Care Act, CMS launched the HRRP in 2010 to incentivize hospitals to reduce hospital readmissions among Medicare beneficiaries. The pay-for-performance penalizes hospitals up to three percent of their reimbursement...


More Articles

Medicare, Medicaid Reimbursement $76.8B Under Hospital Costs

by Jacqueline LaPointe

The largest public payers continue to underpay hospitals, data from the most recent American Hospital Association (AHA) Annual Survey of Hospitals revealed. Medicare and Medicaid reimbursement fell $76.8 billion short of the actual costs...

Opioid Overdose Care Totals $1.94B in Annual Hospital Costs

by Jacqueline LaPointe

The opioid crisis is hitting hospital costs, a recent analysis by healthcare improvement company Premier uncovered. Approximately $1.94 billion in annual hospital costs were attributable to patients who experienced an opioid overdose...

Hospitals Weigh in on Medicare DSH Payment Supreme Court Case

by Jacqueline LaPointe

Major hospitals and medical colleges recently urged the Supreme Court to affirm a DC Circuit Court decision that HHS violated the Medicare Act when the department altered the reimbursement adjustment formula for Medicare disproportionate...

HHS Overstepped Authority with 340B Reimbursement Cuts, Judge Rules

by Jacqueline LaPointe

A federal judge in Washington DC recently struck down a nearly 30 percent reduction in 340B reimbursement cuts. US District Judge Rudolph Contreras ruled that HHS Secretary Alex Azar exceeded his statutory authority by issuing a policy...

Hospital Wage Data Inaccuracies Led to Medicare Reimbursement Issues

by Jacqueline LaPointe

CMS may not be appropriately adjusting Medicare reimbursement to hospitals for local labor prices, a new HHS Office of the Inspector (OIG) report reveals. The HHS watchdog found “significant vulnerabilities” in the hospital...

CMS Paid $4M in Excess GME Medicare Reimbursement, OIG Finds

by Jacqueline LaPointe

Audits performed by the HHS Office of Inspector General (OIG) showed that hospitals received excess Graduate Medical Education (GME) Medicare reimbursement after counting residents and interns as more than one full-time equivalent...

More Site-Neutral Payments to Impact Value-Based Care, Reps Says

by Jacqueline LaPointe

Over 130 members of the House of Representatives recently urged CMS to reconsider a proposed expansion of site-neutral payments to grandfathered off-campus provider-based hospital departments in 2019. The Oct. 18, 2018 letter to CMS...

200 Hospitals Face 5.5% Medicare Payment Cut Under Site-Neutral Rule

by Jacqueline LaPointe

About six percent of hospitals subject to the Medicare Outpatient Prospective Payment System (OPPS) would be disproportionately impacted by a recent proposal to expand site-neutral Medicare payments, a new analysis shows. The 200...

Medicare DSH Payment Case Makes Its Way to the Supreme Court

by Jacqueline LaPointe

The Supreme Court recently agreed to review an appeal on a case that could affect up to $4 billion in Medicare Disproportionate Share Hospital (DSH) payments. Supreme Court judges approved a request from HHS to revisit an appellate...

Federal Policies to Decrease Hospital Payments by $218B by 2028

by Jacqueline LaPointe

Several federal policies since 2010 will reduce hospital payments by a total of $218.2 billion by 2028, a new report from the health economics consulting firm Dobson | DaVanzo and Associates revealed. The report commissioned by the...

CMS OKs Maryland’s All-Payer Alternative Payment Model Expansion

by Jacqueline LaPointe

CMS greenlighted an expansion of an all-payer alternative payment model in Maryland that allows the state to set hospital reimbursement rates, the office of Governor Larry Hogan recently announced. Maryland’s unique alternative...

Medical Prices Grew 28% for Hospital E&M Services Since 2012

by Jacqueline LaPointe

Medical prices for hospital evaluation and management (E&M) services rose 28 percent and allowed amounts increased 26 percent between May 2012 and 2017, the most recent FH Medical Price Index from FAIR Health revealed. The analysis of...

Fewer Hospitalizations Reduced Skilled Nursing Facility Use by 15%

by Jacqueline LaPointe

Skilled nursing facility (SNF) utilization has declined 15 percent from 2009 to 2016, a new Avalere analysis revealed. The analysis of Medicare fee-for-service claims revealed that SNF utilization dropped from 1,808 SNF days per 1,000...

MO Court Bans CMS from Altering DSH Medicaid Reimbursement Rules

by Jacqueline LaPointe

A District Court in Missouri prohibited CMS from enforcing a 2017 final rule and two Frequently Asked Questions (FAQs) from 2010 that would alter the formula for calculating hospital-specific limits for  Medicaid reimbursement under...

Hospital Cost-Shifting Increases Private Payer Payments by 1.6%

by Jacqueline LaPointe

Healthcare organizations that faced Medicare reimbursement reductions under the Affordable Care Act engaged in hospital cost-shifting that resulted in 1.6 percent higher average payments from private payers, a new working paper from the...

Limited Quality Benefits for Early Pay-For-Performance Adopters

by Jacqueline LaPointe

The impact of hospital pay-for-performance models, such as Medicare’s Hospital Value-Based Purchasing Program (HVBP), have been “limited and disappointing” over the past decade, researchers stated in a new BMJ study. The...

3 Strategies to Reduce Hospital Readmission Rates, Costs

by Jacqueline LaPointe

Providers understand that high hospital readmission rates spell trouble for patient outcomes. But excessive rates may also threaten a hospital's financial health, especially in a value-based reimbursement...

AHA Opposes Medicare Reimbursement Cut for Early Hospice Care

by Jacqueline LaPointe

Congress should not pass a proposed policy to reduce Medicare reimbursement rates to hospitals discharging patients to hospice care earlier than the expected, the American Hospital Association (AHA) advised. The proposed policy builds on...

X

Join 30,000 of your peers and get free access to all webcasts and exclusive content

Sign up for our free newsletter:

Our privacy policy


no, thanks

Continue to site...