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

Uncompensated Care Costs

Hospital Cost Shifting Still Occurring in CO Despite Coverage Gains

February 26, 2019 - Despite higher Medicaid reimbursement, fewer uninsured individuals, and less uncompensated care costs, hospital cost shifting to commercial payers did not subside in Colorado. Those are the findings from a new draft report from the state’s Department of Health Care Policy and Financing (HCPF). The department recently used research from its own reports, the Colorado Health...


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Finding Medicaid Eligibility Cuts Hospital Bad Debt by 10%

by Jacqueline LaPointe

Extending insurance discovery efforts to insured patients can boost a hospital’s Medicare bad debt recovery by as much as ten percent annually, a new analysis shows. Identifying insured patients who are also eligible for Medicaid...

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...

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 on Medicaid Disproportionate Share...

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...

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 identified financial obstacles as the top...

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 from the AHA’s Annual Survey of...

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 hospital closure rate decreased by 0.33 per...

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 of $1 billion per year in Medicaid...

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 AcademyHealth research revealed. After analyzing...

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 uncompensated care costs and...

NH Judge Rejects CMS FAQs Clarifying Medicaid DSH Payments

by Jacqueline LaPointe

A district court in New Hampshire recently prohibited CMS from enforcing two Frequently Asked Questions (FAQs) that clarified how private payer and Medicare reimbursements paid to hospitals for dually-eligible Medicaid patients would be...

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...

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,...

Children’s Hospitals Vulnerable to Uncompensated Care Cuts

by Jacqueline LaPointe

Pediatric healthcare providers, especially those practicing in free-standing children’s hospitals, could face serious financial setbacks following upcoming uncompensated care payment reductions as mandated by the Affordable Care Act,...

AHA Urges CMS to Withdraw Uncompensated Care Payment Changes

by Jacqueline LaPointe

The American Hospital Association (AHA) recently penned a letter to CMS Acting Administrator Andy Slavitt urging the federal agency to withdraw its proposed rule to include third-party payments, such as private payer and Medicare...

CMS Clarifies Medicaid Uncompensated Care Reimbursement Plan

by Jacqueline LaPointe

CMS plans to use third party and Medicare claims reimbursements to calculate hospital-specific uncompensated care costs and distribute Medicaid Disproportionate Share Hospital payments, according to a proposed rule from the federal...

GAO: Medicare Uncompensated Care Aid Not Based on Actual Costs

by Jacqueline LaPointe

Medicare’s uncompensated care payments to hospitals do not account for the actual healthcare costs associated with treating large proportions of Medicaid and uninsured patients, according to a recent Government Accountability Office...

Hospital Profitability Rises by 35% in Oregon After ACA Passage

by Jacqueline LaPointe

Hospital profitability has increased for healthcare organizations across Oregon since the passage of the Affordable Care Act (ACA) in 2010, which enabled more individuals to become insured, the Oregon Health Authority has found. The report...

Uncompensated Care Drops by $6B after Medicaid Expansion

by Jacqueline LaPointe

Numerous individuals seek necessary medical services at hospitals regardless the ability to pay, but uncompensated care costs from charity cares and patient debt can strain hospital revenue cycles. However, as states develop Medicaid...

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