Accounting & Financial Management

For the second year in a row, Humana ranked first in overall performance among 148 payers, according to the 2014 PayerView Report. The report ranks health insurers according to specific measures of financial, administrative and transactional performance.

The federal government and a number of hospitals may want to transition to a new Medicare reimbursement model. But there are still billions of dollars in disputed fee-for-service claims waiting to be settled, sowing animosity between health systems and the feds.

While majorities of healthcare providers see value-based payment models becoming the reimbursement status quo in coming years, fewer than one-in-three say the reward is worth the risk.

According to a study published this week in Health Affairs, the Great Recession did not have a permanent negative financial impact on vulnerable hospitals, such as safety net facilities, or those considered financially weak prior to the recession. However, this doesn't mean these same hospitals will fare so well in coming years.

Increased admissions drove revenue gains for Tenet Healthcare Corporation and Community Health Systems in the first quarter of 2014 compared to 2013. Both for-profit hospital firms appear confident midway through Q2.

With fewer resources available and a need to control and better understand costs, UPMC has piloted a cost-analysis system that may become a national model.

Aggregated clinical data are essential to managing population health. But analyzing the financial health of various service lines is a complex undertaking.

As a result of the push towards accountable care, increased patient census no longer translates to higher revenue for hospitals. Unless costs are managed internally, higher patient volume may instead lead to narrower margins, if not outright red ink.

With the rise of value-based payment and care models, long-term hospital viability may depend on not only getting a better handle on costs, but also being able to link them to outcomes. To achieve this, hospitals need cost accounting on steroids.

In case anyone was wondering, the RACs haven't gone away for good. They're just taking a vacation. The Centers for Medicare & Medicaid Services announced a "pause" in RAC audits last month, in preparation for the procurement of the next round of RAC contracts.