Reimbursement

Here are some tips for your next optimization, starting with identifying KPIs to creating an ongoing optimization culture.

<p class="MsoNoSpacing"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">This week's top stories include Physician Partners of America agreeing to pay $24.5M to settle a number of alleged violations, including unnecessary testing, and CMS estimates that payments to acute care hospitals will increase in 2023 by $1.6B. </span></span></p>

<p>This week's top stories include providers aiming to extend the public health emergency that ushered in waivers and flexibilities during the pandemic, and clinicians at DOD, Coast Guard and VA sites could not update medical information for hours.</p>

Over 700,000 more consumers have signed up for coverage this year than last year.

Other contributing factors include the emergence of new technologies, vaccine mandates and more federal scrutiny of mergers.

Average payments are $58,000 for small providers, $289,000 for medium providers, and $1.7 million for larger providers.

The rule, which goes into effect in January, gives insurers incentive to exclude higher-cost specialized services from their networks, lawsuit says. 

<p class="MsoNoSpacing">This week's top stories include the formation of Telehealth Access for America, which aims to protect and expand access to telehealth, and a last-minute deal that averted massive cuts to reimbursement to hospitals and physicians.</p>

Those employed by health systems had about 49% lower Medicare billing, worked more hours per week and were in practice for fewer years.

Lower-rated hospitals that have full intensive care units are less able than higher-rated hospitals to absorb a decline in reimbursement.