Claims Processing

With Medicare's "two midnight rule" set to take effect later this year and audit appeals facing lengthy backlogs, the Recovery Audit Contractor program may be headed in some new directions.

An unusual 90-day grace period for government-subsidized health plans may leave physicians at risk for not getting paid for their services.

The financial impact of the two midnights rule remains an open question and so is whether recovery auditors will challenge fewer claims or just shift their focus.

Despite the hassle of auto-cancellations, many home healthcare agencies find it difficult to keep track of their requests for anticipated payment.

There's still plenty of work to do before the Oct. 1 ICD-10 deadline. A recent study found that only 4.8 percent of physician practices reported significant progress in overall ICD-10 readiness. Hospitals report higher levels, but many are still behind.

Healthcare is one of the last bastions of consumer-unfriendly billing and pricing. As individuals start to take on more responsibility for premiums, deductibles and co-pays, they are increasingly demanding more transparency. And providers will be forced to respond.

Although highly touted, the patient-centered medical home model failed to lower use of services or total costs and produced little quality improvement over three years, research in the latest Journal of the American Medical Association has found.

With the threat of significant reimbursement losses, hospitals and health systems are feeling the pressure of getting the transition to ICD-10 right.

Bundled payment and payment reform in general are hot topics in healthcare circles, and will prove to be a challenge for many. Jay Sultan, thought leader for payment reform at TriZetto, a healthcare management solutions company, shared with Healthcare Finance News five key ideas for hospital leaders to consider in order to break barriers to successfully implement payment reform at their organizations.

Consumer-directed health plans with high deductibles typically exempt recommended preventive care such as annual physicals or screening tests from the plan's deductible or require only a small copay as a way to ease financial barriers and encourage patients to seek care. However, many patients don't understand their plan benefits for preventative office care and tend to avoid visits altogether.