Having been on the receiving end of audits, and also having been an individual who has conducted them, I know the mindset from both sides of this equation. The one element to this equation that has changed over time is the increase in payer denials: those that are now clinical- and coding-focused, often resulting in […]
the payer giant is accused of forcing physician groups out of network to lure them to its subsidiary, Optum. UnitedHealth is the target of a lawsuit by Envision Healthcare and several other physician practices, who claim the country’s largest health insurer engages in a nationwide practice of low reimbursement rates for providers to force […]
Here are the six best reimbursement stories from 2021 HealthLeaders’ coverage and beyond. COVID-19 continued to impact healthcare reimbursement as the pandemic entered its second year. Yet, what’s different is that longer-term strategies and new business opportunities are emerging beyond crisis response. The Centers for Medicare & Medicaid Services (CMS) aided these plans by […]
COVID-19 hospitalization costs varied by state, with the highest in-network cost averaging $128,650. According to a new FAIR Health study, COVID-19 hospitalization cost varies by state, with complex hospitalizations for COVID-19 in-network average cost maxing out at $128,650. “Behind the numbers of our COVID-19 Cost Tracker are the individuals who have contracted COVID-19. As a […]
The number of beneficiaries in traditional Medicare using telehealth exploded 63-fold in 2020 from 840,000 in 2019 to nearly 52.7 million, a new study found. The study, released Friday (PDF) by the Department of Health and Human Services (HHS), comes as advocates are pressing to make key flexibilities the federal government enabled at the start […]
The world is changing and the operations behind healthcare reimbursement is changing with it. Healthcare organizations are recovering from an unprecedented public health crisis during which entire service lines shut down so providers could focus on stopping the spread of a deadly virus. Meanwhile, healthcare has been going through a digital revolution. The clinical shift […]
Inefficiency is an issue that continues to plague many areas of healthcare, particularly when it comes to manual administrative functions. While the industry is increasingly harnessing technology – evidenced by the use of telehealth and the push for electronic health record interoperability – administrative complexity continues to be burdensome, and largely paper- and fax-driven. This […]
Physicians are asking for adequate reimbursement for all COVID-19 vaccines and their administration, according to a new policy statement from the American College of Physicians (ACP). The statement released on Jan. 12 calls on health policymakers to require insurers to “provide adequate reimbursement for all vaccines, including COVID-19 vaccines, administered according to” scientific guidelines established by […]
Healthcare providers face two new rules certain to complicate a busy year already dominated by the pandemic. The nation’s capital is facing a tremendous number of complex issues this week. Amid all this, legislative activity on two healthcare policy initiatives has advanced in the past few weeks – and those two initiatives will add […]
Healthcare is the industry most at-risk during the coronavirus (COVID-19) pandemic. Providers are on the front lines of response efforts. At the same time, the financial implications of the pandemic are also creating significant revenue cycle challenges, putting providers even more at risk during the pandemic. Individuals are postponing non-emergency care for many reasons, from […]