Medicaid Reimbursement

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...

Fixing Medicare, Medicaid a Top Priority for New Coalition

by Jacqueline LaPointe

Healthcare industry heavy-hitters are partnering to form a new coalition that generally aims to “improve what’s working in health care and fix what’s not,” especially in...

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...

Medical Billing Complexity Highest for Medicaid Fee-for-Service

by Jacqueline LaPointe

Medical billing for Medicaid fee-for-service claims proved to be the most complex across all insurers. The public payer had a claims denial rate 17.8 percentage points greater than the rate for...

Judge Voids CMS Rule Altering Medicaid DSH Payment Calculations

by Jacqueline LaPointe

A US District Court for Washington DC recently vacated a CMS final rule from 2017 that required third-party payments, including those from Medicare, to be used when calculating hospital-specific limits...

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...

Drug Prices, Medicaid Reform Major Themes in Trump’s HHS Budget

by Jacqueline LaPointe

President Trump plans to decrease HHS funding by about 21 percent compared to 2017, while focusing the federal department’s budget on prescription drug prices reductions and Medicaid reform,...

Financial Challenges Continue to Trouble Community Hospital CEOs

by Jacqueline LaPointe

Financial challenges continued to keep community hospital CEOs up at night in 2017, according to a recent American College of Healthcare Executives (ACHE) survey. Once again, hospital leaders...

Reimbursement Shortfalls, Uncompensated Care Costs Grew in 2016

by Jacqueline LaPointe

Medicaid and Medicare reimbursement in 2016 was $68.8 billion short of actual hospital costs for treating beneficiaries, according to data from the American Hospital Association (AHA). The information...

Hospital Closures Increased in States Without Medicaid Expansion

by Jacqueline LaPointe

Hospitals in Medicaid expansion states were six times, or about 84 percent, less likely to face hospital closures than their peers in non-expansion states, a new Health Affairs study showed. The...

Prioritizing Value-Based Care, Affordability in Medicaid

by Jacqueline LaPointe

WASHINGTON DC - The future of Medicaid involves providing value-based care at an affordable price for all beneficiaries in the program, Kaiser Permanente’s CEO Bernard J. Tyson told attendees at...

Reps Eye Delay for Medicaid Disproportionate Share Hospital Cuts

by Jacqueline LaPointe

Three House Representatives recently called on their Congressional peers to postpone implementing a rule that would reduce Medicaid Disproportionate Share Hospital (DSH) payments starting on Oct. 1,...

Cost Savings Unclear for Medicaid Alternative Payment Models

by Jacqueline LaPointe

Alongside Medicare and private payers, states are making the switch to value-based reimbursement, but states and independent researchers have yet to demonstrate the impact of Medicaid alternative...

Medicaid Reimbursement Woes Key Concern for Healthcare CEOs

by Jacqueline LaPointe

Approximately 85 percent of healthcare executives identified shrinking Medicaid reimbursement rates and funding as a top concern in 2017, according to a new Deloitte survey. Deloitte surveyed 20 CEOs...

CMS Details $43B Drop in Medicaid Uncompensated Care Support

by Jacqueline LaPointe

In a recently proposed rule, CMS outlined a methodology for reducing Medicaid support for hospitals incurring significant uncompensated care costs starting in 2018. The rule would implement reductions...

Hospitals Saw No Effect on Margins After Medicaid Expansion

by Jacqueline LaPointe

The net impact of Medicaid expansion on non-profit hospital finances was close to zero because uncompensated care cost reductions did not offset Medicaid reimbursement shortfalls, a recent...

Pediatric Healthcare Costs 35% Less at Community Health Centers

by Jacqueline LaPointe

Pediatric healthcare costs were $1,133 on average among children primarily using community health centers for care versus $1,750 among children seeing other providers, representing a 35 percent...

The Difference Between Medicare and Medicaid Reimbursement

by Jacqueline LaPointe

Medicare and Medicaid are government healthcare programs that help individuals acquire coverage, but similarities between the programs more or less end there. Medicare and Medicaid reimbursement structures vary significantly by program and...

2016 Medicaid, Medicare Improper Payments Over Regulatory Cap

by Jacqueline LaPointe

A recent Office of the Inspector General (OIG) report revealed that the rates of Medicaid and Medicare improper payments in 2016 exceeded the legislative threshold of less than 10 percent. The...

AHA: Uncompensated Care Costs Worksheet Inaccurate, Inconsistent

by Jacqueline LaPointe

The American Hospital Association (AHA) recently called on CMS to audit and modify the hospital cost report, Worksheet S-10, before the federal agency uses the report to determine each hospital’s...