Policy and Legislation
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.
Even as the Affordable Care Act is in its nascent stages, some states are already looking toward 2017 when they can request waivers to opt out of the healthcare exchanges. And a small, but persistent, movement has popped up toward a single payer system as an alternative to participating in the exchanges.
With several states weighing whether to expand Medicaid under the federal health law, supporters are looking to powerful business groups to help sway skeptical state legislators. But those groups are split on the issue -- just like the public at large.
Despite the hassle of auto-cancellations, many home healthcare agencies find it difficult to keep track of their requests for anticipated payment.
A new federal regulatory proposal to ensure adequate insurance networks could help not-for-profit hospitals, Moody's said in a briefing released this week.
The number of people determined eligible for Medicaid since the launch of new insurance marketplaces is approaching 10 million, according to new data released from the Centers for Medicare & Medicaid Services.
The recent delay of the employer mandate for medium-sized businesses will harm not-for-profit hospitals because it postpones increased revenues from expanded coverage of previously uninsured patients and the subsequent reduction in bad debt and charity care it would bring, a Moody's report said.
Identifying an individual's health plan sounds pretty straightforward. Most hospitals have an eligibility system to verify a patient's coverage for a specific set of services from specific insurance companies. But as coverage expands and gets more complex, so do the pressures on hospitals.
Medicare accountable care organizations are having varying rates of success in addressing their patients' diabetes and heart disease, according to government data released Friday.
Lawmakers took another step toward repealing the reviled sustainable growth rate formula that sets physician payment in the Medicare program, but they still haven't figured out how to pay for it.