Managing the Revenue Cycle in a Reimbursement System that promises to reward “Outcomes” not just “Encounters”. The Accountable Care Organization which has been a pilot program for several years is the closest Medicare has come to rewarding something other than Encounters. For the most part, The ACO’s are not realizing the bonuses they were going… Continue Reading
WSJ | By ANNE TERGESEN | Date: June 22, 2016 Nearly a third of all Medicare beneficiaries face a steep increase in their premiums next year, the result of a policy that in certain circumstances requires some beneficiaries, including higher earners, to shoulder the burden of rising costs. The government health-care plan’s trustees projected in a report… Continue Reading
For years CMS has encouraged, indeed motivated, Hospitals and Health Systems to migrate as much as possible from the inpatient setting to the Outpatient one. Now there is a revolution in which physicians/Surgeons either in conjunction with a hospital or independently opened very successful Outpatient Surgery Centers, thus taking much revenue away from the Hospitals.… Continue Reading
Health Systems Management Network, Inc has reviewed the new rule which is in the comment stage. The rule is 947 pages long and difficult to digest. In a recent article published this week in Modern Health Care written by Beth Kutscher and Adam Rubenfire, these two terrific writers have tried their best and succeeded in… Continue Reading
Upcoding seems to be the common link between the Medicare payment reduction related to the “Two Midnight rule” and a new wrinkle in which CMS will double the expected payment reduction, which has been meant to recoup overpayments tied to INCORRECT CODING. CMS introduced MS-DRG a suggestion from the Medical community and hospitals to account… Continue Reading
Modern Health Care is reporting today that the “Payment Rates for Insurers who sell Medicare Advantage Plans will rise by 0.85% instead of 1.35% in the Proposed Increase. The most interesting fact about the size of the increase (very small) is that CMS took into account the way health plans code their members DIAGNOSES. THUS… Continue Reading
In the most ideal world patients could choose physicians on the basis of the “Quality Scores” provided by some independent entity like a “Physician Consumer Reports”. According to a study funded by the Physicians Foundation, the data suggest that this effort should be made a priority. Furthermore physicians should be paid on the basis of… Continue Reading
ACA losses for a number of insurance companies have been staggering because of the traditionally small margins with which they are confined by contract. The Revenue Cycle is in turmoil because companies like HIGHMARK (a Blue Cross/Blue Shield affiliate) will ding physicians with whom they are affiliated by 4.5%. Until this point the physicians were… Continue Reading
CMS is going after Medicare Over payments in a big way. Just like Willy Sutton, they are going to where the money is. Does your CFO know if there are overpayments and how much they are worth? Have you done any focused reviews to unearth this information? The tools for CMS to unlock your vault… Continue Reading
HSMN has taken note of a Washington Post Opinion article written by Newt Gingrich and Tom Daschle in which they advocate using the provisions in Section 1332 of the Affordable Care Act. In essence this section creates a process for generating “State Innovation Waivers. These are limited but allow States to begin to experiment so… Continue Reading
