Revenue Cycle Management

One of the major arguments against the ICD-10 transition are the financial costs to medical practices. Sure, there are accusations of bureaucratic overreach, but the anti-ICD-10 argument is primarily financial. So why not offer providers an incentive?

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.

Bundled payments represent a new and increasingly accepted form of reimbursement. They can work now, if applied in modest, manageable ways from which lessons can be learned and applied more broadly later.

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.

On Oct. 1, 2013, I marked the 12-month countdown to ICD-10 implementation by attempting to answer some basic questions. Now that more than six months have passed, and we have another deadline delay, many healthcare providers still can't get satisfactory answers.