Tag: Medicare Beneficiary

Pushing Back Against Medicare Advantage SNF Denials

Pushing Back Against Medicare Advantage SNF Denials: Part 1

Despite ongoing concerns about denials and beneficiary access to care, Medicare Advantage (MA) companies remain in the spotlight as their market penetration continues to grow. In April 2022, a report from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) highlighted a significant issue in the capitated payment model employed […]
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Bottom-Line-in-Healthcare

Get To The Bottom Line In Healthcare

To understand this dynamic, you need to know who the customer is. One of the key questions arising from looking at financial statements is this: how do we “get to the bottom line” in healthcare? In our society and culture, we have a fascination with the term “net income,” but it may have little meaning […]
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Billing-Patients-Insurers-Messages

A Medical Center Bills Patients’ Insurers For Messages

  One of the nation’s largest hospital systems has begun charging for some electronic messages its doctors send to patients. On November 17 the hospital system began billing patients’ insurers for messages that typically take more than five minutes to answer and require a doctor’s “medical expertise,” according to an announcement on their website. Among […]
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Value-based-care-catching-up-to-FFS

Value-Based Care Catching up to Fee-For-Service

Outcomes-based models are spreading, but fee-for-service still dominates payment landscape. Is value-based care having a moment? Health care policy experts and institutions have long agreed that fee-for-service (FFS) medicine is wasteful, outmoded and at least partially responsible for the U.S. spending far more than peer nations on health care, but with outcomes that are no […]
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