Revenue Cycle Management
Medicaid beneficiaries deserve the same access to healthcare services and products as people with commercial insurance or Medicare. But since Medicaid pays doctors and hospitals 27 to 65 percent less than commercial health plans, it makes it awfully difficult for providers to be payer agnostic.
With patients paying more out-of-pocket costs and exchanges increasing the number of plans providers deal with, having financial counselors in a practice may become a necessity.
Even though it has not been determined what impact the health insurance exchanges will have on hospital finances, there are steps hospitals can take to increase the likelihood of positive effects on their revenue cycles.
Medicare announced Friday that it was revising rules intended to prevent the agency from paying twice for the same prescriptions for seniors receiving hospice care. The drug categories in question were identified in a 2012 investigation by the HHS inspector general.
Facing threats to net revenue, most healthcare organizations have embarked on massive cost reduction initiatives. Unfortunately, the first tactic for many of these initiatives continues to be a "tried and true" approach which is often ineffective -- operational benchmarking.
If we don't fundamentally change the way we pay for healthcare, we won't change the economic principles that continue to drive the rapid growth in healthcare spending. Let's pay physicians and hospitals based on the health problems their patients have.
Healthcare prices in May 2014 were 1.8 percent higher than in May 2013, well above the 12-month moving average of 1.3 percent, according to a recent brief from the Altarum Institute.
Hospices can now lose Medicare payments if they don’t file cost reports, and yet, because there are no penalties for inaccurate reporting, there is little motivation to spend much time on them.
The Affordable Care Act included a number of delivery system reforms, such as ACOs, bundled payments, and workforce provisions to strengthen foundations in primary care. Unfortunately, a focused effort on payments for specialists was not included.
To boost patient satisfaction scores and compete with urgent care centers and walk-in clinics, hospitals are allowing patients to book appointments in the ER.