Accounting & Financial Management
As providers continue adjusting to the reimbursement changes wrought by the Affordable Care Act, it appears increasingly likely that hospitals will place more emphasis on collecting payments at the point of service.
The American Hospital Association is asking federal Medicare leaders to stem the practice of using sample hospital audit data to extrapolate overpayments eligible for recovery. The lack of clarity regarding standards for short patient stays has clouded the issue.
States' taxing of Medicaid managed care organizations to raise revenue for state-share Medicaid payments may be illegal, according to the HHS Inspector General. If so, this raises serious questions that could shake up MCO financing models.
One third of Pennsylvania's hospitals had negative operating margins in the 2013 fiscal year, according to the Pennsylvania Healthcare Cost Containment Council, an independent state agency. The crisis is forcing health systems to rethink organizational mergers and management.
New research suggests that accountable care organizations should make payments to patient-centered medical homes or take other steps to support them financially, since their goals are similarly transformative.
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.
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.
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.
According to a study published this week in Health Affairs, the Great Recession did not have a permanent negative financial impact on vulnerable hospitals, such as safety net facilities, or those considered financially weak prior to the recession. However, this doesn't mean these same hospitals will fare so well in coming years.
Increased admissions drove revenue gains for Tenet Healthcare Corporation and Community Health Systems in the first quarter of 2014 compared to 2013. Both for-profit hospital firms appear confident midway through Q2.