Revenue Cycle Management

Medicare may be overpaying hospitals an estimated $5 billion as a result of the 18-month moratorium on enforcing the controversial two-midnight rule that tells hospitals when patients should be admitted, according to an independent Medicare auditing company.

A new interpretation of a 40-year-old law could offer healthcare providers more options for appealing payer recoupments or preventing them altogether.

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.

Implementation of the Affordable Care Act is likely to lead to increased profitability for hospital emergency departments.

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

Hospitals are educating their staff and reworking their processes to comply with Medicare's two-midnight rule, which will likely reduce hospital revenue by shifting patients from inpatient to outpatient status.

Keeping a hospital's revenue cycle healthy while transitioning to outcome-based quality payments requires both a "hard" and "soft" approach.

Lack of preparation, even with the implementation delay, spells revenue cycle disruption.

Many not-for-profit hospitals are still struggling to align revenue with capital deployment and expenses, a challenge that may grow as patients come in covered by exchange plans and Medicaid.

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.