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

Hospital Revenue Cycle

Should the Hospital Readmissions Reduction Program Add Sepsis?

by Jacqueline LaPointe

The Medicare Hospital Readmission Reduction Program currently determines value-based penalties on 30-day unplanned readmissions rates for six conditions. But the value-based reimbursement program may be missing a key condition that...

CMS Clarifies Site-Neutral Medicare Reimbursement Exceptions

by Jacqueline LaPointe

With the site-neutral Medicare reimbursement policy taking effect on Jan. 1, CMS recently released guidance on what hospital departments qualify for exemption from the rule. The federal agency clarified expanded site-neutral payment...

Market Power, Not Quality Linked to Higher Healthcare Costs

by Jacqueline LaPointe

Higher healthcare costs at New York hospitals are linked to increased market power and not higher quality of care, the New York State Health Foundation recently reported. More expensive hospitals tended to have increased market leverage,...

AHA Asks CMS to Increase Site-Neutral Medicare Reimbursement

by Jacqueline LaPointe

The American Hospital Association (AHA) recently advised CMS to increase Medicare reimbursement rates to off-campus provider-based outpatient departments that will be paid under site-neutral payment rules starting on Jan. 1, 2017. The...

Medicaid, Medicare Reimbursement $57.8B Below Hospital Costs

by Jacqueline LaPointe

Medicaid and Medicare reimbursement in 2015 was under actual hospital costs for treating beneficiaries by $57.8 billion, the American Hospital Association (AHA) recently reported. According to data from the AHA’s Annual Survey of US...

Does Hospital Size Impact Value-Based Penalties in CMS Program?

by Jacqueline LaPointe

Value-based penalties in the Medicare Hospital-Acquired Condition Reduction Program are disproportionately affected by a participating hospital’s bed size and number of cases, a recent American Journal of Medical Quality study...

Unexpected Patient Financial Responsibility in 20% of ED Cases

by Jacqueline LaPointe

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...

Value-Based Care, Hospital Revenue Cycle Lead Top 2016 Stories

by Jacqueline LaPointe

From the final MACRA implementation rule to new value-based care initiatives, 2016 certainly did not leave healthcare providers bored at their desks. Instead, providers were busy digesting changes to reimbursement structures and...

AHA, FAH: ACA Repeal Could Cost Hospital Revenue Cycle Billions

by Jacqueline LaPointe

Providers could face billions in hospital revenue cycle losses if the Affordable Care Act is repealed without replacement legislation that preserves health coverage increases and rolls back claims reimbursement cuts, stated the American...

Do Medicaid Reimbursement, Admissions Produce Hospital Profit?

by Jacqueline LaPointe

Do Medicaid reimbursement rates and federal uncompensated care payments really cover the healthcare costs of treating larger proportions of Medicaid beneficiaries and uninsured individuals? Two new studies in Health Affairs indicate yes,...

NY Senator Challenges Rural Medicare Reimbursement Repayment

by Jacqueline LaPointe

New York Senator Charles Schumer (D-NY) recently spoke out against a CMS plan to recoup supplemental Medicare reimbursement to rural hospitals that could cause hospitals in New York alone to repay the federal agency $15 to $20 million for...

How a Small Hospital Increased Patient Collections by 300%

by Jacqueline LaPointe

As patient financial responsibility continues to increase in a more consumer-focused healthcare environment, more hospitals are shifting healthcare revenue cycle management strategies to improve patient collections. Iroquois Memorial...

CMS Proposes to Limit Supplemental Medicaid Reimbursement

by Jacqueline LaPointe

CMS recently proposed a rule that would limit a state’s ability to create or increase a Medicaid reimbursement structure for hospitals, physicians, and nursing homes that pays providers for services that are not related to care...

Does Higher Hospital Profitability Drive Up Healthcare Costs?

by Jacqueline LaPointe

The push to maximize hospital profitability across for- and non-profit organizations is driving up healthcare costs, contends a new commentary in The American Journal of Medicine. Hospitals are focusing on boosting profitability rather...

Large Hospitals Fare Worse in Value-Based Reimbursement Model

by Jacqueline LaPointe

Large hospitals averaging approximately 260 staffed beds were more likely to receive a negative value-based reimbursement adjustment under a hospital-specific Medicare program in 2016, according to a recent report from Definitive...

CMS: Over Half in Value-Based Care Program to Earn Bonuses

by Jacqueline LaPointe

Over 1,600 hospitals in the Hospital Value-Based Purchasing Program, representing over 50 percent of total participants, will receive positive Medicare payment adjustments in 2017 for value-based care performance, CMS reported in a recent...

How to Adopt a Retail Approach to Boost Healthcare Transparency

by Jacqueline LaPointe

More hospitals are implementing healthcare transparency strategies that borrow from the retail industry in order to retain and attract consumers, according to a recent PricewaterhouseCoopers Health Research Institute report. The report...

CMS: Rural Healthcare Faces Hospital Revenue Cycle Challenges

by Jacqueline LaPointe

In a statement at the CMS Rural Health Summit yesterday, CMS Acting Administrator Andy Slavitt identified rural communities as one of the biggest opportunities for healthcare reform because rural areas face more hospital revenue cycle...

Hospitals Saw 23% Rise in Inpatient Prescription Drug Spending

by Jacqueline LaPointe

Hospital inpatient prescription drug spending has increased by 23.4 percent from 2013 to 2015, reported a recent study from the University of Chicago’s NORC. The increases in spending have left most providers struggling to manage...

CBO: Future Hospital Profitability Requires More Productivity

by Jacqueline LaPointe

To stabilize hospital profitability at a six-percent average profit margin by 2025, providers must increase hospital productivity to offset Affordable Care Act provisions to decrease federal reimbursement rates and implement value-based...

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