Revenue Cycle Management

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.

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.