Revenue Cycle Management

The Affordable Care Act was designed to make medical care less expensive for the American public; it was not intended to put healthcare providers out of business. But a recent analysis of U.S. hospitals suggests the law could contribute to the demise of hundreds of poor performers.

Hospitals in states that have expanded Medicaid eligibility under the Affordable Care Act are already bringing in fewer self-pay and charity care patient cases, according to an analysis by the Colorado Hospital Association.

As providers continue adjusting to the reimbursement changes wrought by the Affordable Care Act, it appears increasingly likely that hospitals will place more emphasis on collecting payments at the point of service.

The American Hospital Association is asking federal Medicare leaders to stem the practice of using sample hospital audit data to extrapolate overpayments eligible for recovery. The lack of clarity regarding standards for short patient stays has clouded the issue.

States' taxing of Medicaid managed care organizations to raise revenue for state-share Medicaid payments may be illegal, according to the HHS Inspector General. If so, this raises serious questions that could shake up MCO financing models.

Patient satisfaction surveys suggest patients are unsatisfied and hospitals must do more to engage them. New technologies and techniques can help organizations find new ways to involve patients in their care and connect them with their caregivers.

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.

One of the biggest beneficiaries of healthcare reform's expansion of insurance coverage to more than 13 million people this year has been the nation's safety-net hospitals. At least in the states that have chosen to accept the Medicaid expansion.

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.

With millions of Americans on new health insurance exchange plans now responsible for high deductibles, hospitals, drug makers, insurers and regulators are entering a new frontier of payment disputes.