An industry through leader recaps current challenges to traditional reimbursement models for Medical Economics®. Limited by the slow pace of change in traditional reimbursement models, shifts in the paradigm for patient care have also lagged far behind the possibilities created by transformative technology. The COVID-19 pandemic has changed that, catalyzing improvements in reimbursement by […]
Educated guesses and imprecise, stopgap efforts aren’t enough. Revenue cycles need precise strategies to identify exactly where leakage occurs and implement solid processes to stop leakage before it starts. Even before COVID-19, 250-bed hospitals lost $4.7–$11 million a year from mid–revenue cycle leakage. Now, pandemic-fueled volume losses and razor-thin margins mean that hospitals can no […]
Hospital financial performance improved in April, but margins are still thin as hospital revenue recovers from COVID-19, a report from Kaufman Hall shows. Hospital revenue, volumes, and margins increased in April 2021 both year-to-date and year-over-year, but have a long way to go in terms of COVID-19 recovery, according to a report by health care […]
Miscoding and fraudulent billing can destroy a medical practice. Use these tips to get robust oversight of your medical billing and coding in place. The work billers and coders do for a medical practice plays a large role in its survival. Coders and billers are tasked with translating the care delivered by medical professionals into […]
2022 Hospice proposed rule would help with addendum statement snags, but other problems remain. In the Hospice proposed rule, published in the April 14 Federal Register, the Centers for Medicare & Medicaid Services outlines these changes to the election statement addendum that was implemented on Oct. 1, 2020. Three vs. Five Days In the […]
Previously delayed from March 15th to May 15th, the final rule will now be codified on December 15th, giving CMS time to tackle issues raised by stakeholders. CMS announced that it will delay the effective date of a final rule updating the definition of “reasonable and necessary” and the guidelines surrounding the Medicare Coverage of […]
After three years of policy proposals, the American Medical Association Current Procedural Terminology (CPT) panel responses, and substantial guidance from gastroenterology and other specialty societies, changes to the office/outpatient evaluation and management (E/M) codes became effective as of January 2021. Some aspects of these revisions took effect for telehealth services since spring 2020 for Medicare, […]
It’s critical that independent practices make sure that they are laying the groundwork to make telehealth a robust part of their care delivery and their bottom line. In a very real sense, telehealth has been responsible for enabling independent healthcare practices to stay in practice and continue to provide care to their communities during […]
HHS program reimburses healthcare providers and facilities for testing, treatment, and vaccine administration fees associated with insured patients. On May 3, 2021, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced the new COVID-19 Coverage Assistance Fund (CAF) program that covers costs of administering COVID-19 vaccines […]
ACHP provides several steps that will leverage the advancements of the Affordable Care Act and increase access to high-quality coverage and care. The Alliance of Community Health Plans (ACHP) released recommended steps to build on the success of the Affordable Care Act (ACA) and enhance and expand coverage in the individual health insurance market. First, […]