Revenue Cycle Management
With an improving fiscal climate, some states are paying their Medicaid providers more. More states are increasing fees to specialists, nursing homes and managed care organizations, but 31 states were cutting or freezing Medicaid hospital rates, compared to 19 that were increasing them.
Healthcare providers are realizing they must create and sustain a more effective revenue cycle to ensure long-term viability. To remain competitive, providers must closely evaluate the current state of their revenue cycle and implement improvement opportunities.
The 2015 Medicare Part A deductible -- for inpatient hospital, skilled nursing facility and home healthcare services -- will increase by $44 in calendar year 2015 to $1,260, while the monthly Part A premium will decline by $19. Medicare Part B monthly premiums and deductibles will remain unchanged.
Most hospitals fall well short of their cost reduction targets, in part because the ability of chief financial officers to meaningfully impact how operational and clinical leaders approach the issue is limited.
New research suggests that socioeconomic factors can account for most of the geographical variation in Medicare spending. As a result, larger socio-demographic issues must be considered when assessing the quality of care offered by healthcare providers.
The Centers for Medicare & Medicaid Services has published a final rule updating the hospice wage index and payment rate for Fiscal Year 2015. It adopts a number of payment reforms addressing concerns about program integrity, beneficiary protection and quality.
A program that combines a mobile app, analytics and direct intervention is showing promise in reducing the costs associated with hospitals' most expensive patients -- the so-called "super-utilizers."
The value-based model of healthcare is gradually transitioning from the pilot phase to implementation, as health insurers and providers strive to offer better care while eliminating unnecessary costs. But for providers who have always been paid fee-for-service, it is a different way of thinking.
Predictive analytics uses a variety of statistical techniques that analyze current and historical facts in order to make predictions about the future. In the healthcare setting, such data analysis can be effective in addressing a variety of key issues, including preventable readmissions.
In its new rules, CMS places great emphasis on the physician's documentation regarding his or her expectation of a patient's need for hospital care and anticipated length of stay. Therefore, it is essential that all hospital physicians are educated about the heightened importance of documentation within the medical record.