Claims reimbursement

Providers rely on payer reimbursement to cover the costs of providing healthcare services. Without timely and complete reimbursement, providers may struggle to maintain operations. Effective claims management helps to reduce errors and minimize fraud risk while streamlining the reimbursement process to decrease denials.

Top Stories

News 26 Sep 2024
Three-quarters of providers say claim denials increasing

The growing rate of claim denials poses a threat to healthcare revenue cycle management. Continue Reading
By
- Sara Heath, Executive Editor
News 11 Sep 2024
AMA 2025 CPT code set updates focus on novel genetic testing

The AMA's 2025 CPT code set has 420 updates, including new codes for genetic testing, AI medical services, remote therapeutic monitoring and novel surgical techniques. Continue Reading
By
- Hannah Nelson, Assistant Editor

News 19 Nov 2020
Providers Say They Need More Financial Aid As COVID-19 Cases Rise

AMGA is seeking new funding for the Provider Relief Fund, another round of advance Medicare payment, and more telehealth flexibility to manage the new surge in COVID-19 cases. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 17 Nov 2020
Medicare FFS Improper Payments Down by $15B Since 2016

CMS said efforts to prevent Medicare FFS improper payment and healthcare fraud, waste, and abuse have paid off over the last four years, resulting in $15B in savings. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 16 Nov 2020
Financial Incentives Biggest Barrier to Social Determinants of Health

Funding and supportive financial incentives are the biggest barriers provider organizations cite to successful social determinants of health initiatives, according to a recent Insights by Xtelligent Healthcare Media report. Continue Reading
By
- Emily Sokol, MPH
News 11 Nov 2020
CMS Details Medicare Payment for New COVID-19 Antibody Drug

Medicare payment will be available for the purchase and infusion of bamlanivimab, a COVID-19 antibody drug recently approved by the FDA for emergency use. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 11 Nov 2020
AMA Updates CPT Code Set to Include COVID-19 Vaccine Codes

The organization approved a unique CPT code for each of two COVID-19 vaccines to allow for better tracking, reporting, and analysis of immunization efforts. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 10 Nov 2020
Most Physicians Prefer Single-Payer Option Over Medicare For All

While a single-payer option was the preferred option for healthcare’s future, surveyed physicians also called for more immediate actions, including prior authorization reform and mental health access. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 09 Nov 2020
Telehealth Billing Leveled Out in August, But Still Up 3,552%

Telehealth billing from July to August 2020 was relatively the same as providers ramped up in-person visits after strict lockdowns due to COVID-19. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 09 Nov 2020
Deadline to Provide Billing Info for Advance APM Bonus Approaches

Providers who are missing billing information for the 5% Advanced APM bonus have until Nov. 13 to submit the data to CMS unless providers can sway the agency to reconsider. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 03 Nov 2020
CMS Expands Medicare Reimbursement for Home Dialysis, ESRD

The new Medicare reimbursement add-on for certain home dialysis machines will encourage high-risk ESRD patients to stay home, the agency says. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
Answer 21 Oct 2020
Court Denies Requests to Revisit 340B, Site-Neutral Payment Cases

The cases challenged previous court decisions that upheld Medicare reimbursement cuts for 340B drugs and through site-neutral payment for hospital clinic visits. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 20 Oct 2020
Hospitals to See 10% Fewer Total Admissions Than Projected in 2020

Hospital admissions are on course to fall below projections for the year despite a rebound in hospital stays, new data shows. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 15 Oct 2020
Senators Call for Changes to Provider Relief Fund Reporting

Two separate groups of Senators have urged HHS to reconsider changes to Provider Relief Fund reporting requirements, with some asking the department to reinstate June requirements. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 14 Oct 2020
Limited Reimbursement Paid Out for Uninsured COVID-19 Treatment

With funding contingent on the Provider Relief Fund, a COVID-19 treatment reimbursement program for uninsured patients has a small reach, KFF reported. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 13 Oct 2020
Top 3 Concerns with the 2021 Medicare Physician Fee Schedule Rule

Comments on the 2021 Medicare Physician Fee Schedule proposed rule centered on potential payment cuts, telehealth reimbursement, and quality reporting changes. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
Feature 09 Oct 2020
3 Ways to Improve Medical Coding Quality for Accurate Reimbursement

Leveraging technology, auditing for compliance, and providing robust education are key ways providers can improve medical coding quality. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 07 Oct 2020
AMA Adds CPT Codes for Multi-Virus Tests for COVID-19, Flu

The new CPT codes allow providers to report nucleic acid assays that allow a single test to detect both COVID-19 and other seasonal viruses, like the flu. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 05 Oct 2020
Non-COVID-19 Hospital Admissions Have Only Partially Rebounded

A new study shows that non-COVID-19 hospital admissions hit a low in April and rebounded to 16% below pre-pandemic levels by summer. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 30 Sep 2020
AHA: Reinstate June’s Provider Relief Fund Reporting Requirements

New Provider Relief Fund reporting requirements that override those from a June FAQ are unfair and unrealistic, the hospital group says. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 22 Sep 2020
AHA Contests Study on High Hospital Prices for Privately Insured

The study found that hospital prices are 247% higher than what Medicare would pay and that gap has recently increased, but the AHA says the research is flawed. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 16 Sep 2020
Chronic Care Management Code Use Increases, But Uptake Still Lagging

The use of Medicare’s chronic care management codes increased from 2015 to 2018, but newer codes were used less frequently and 5% of claims with the codes were denied. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 11 Sep 2020
Telehealth Reimbursement Just for Value-Based Providers Post-COVID?

Telehealth reimbursement expansions granted during the PHE may be limited to providers in Advanced APMs moving forward to prevent program integrity issues, MedPAC said at a recent meeting. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 09 Sep 2020
AMA Introduces CPT Code to Account for COVID-19 Safety Protocols

The Association also unveiled another CPT code for tests that quantify COVID-19 antibodies; both CPT codes have been approved for immediate use. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 09 Sep 2020
OIG to Audit Medicare Payments for COVID-19 Discharges

The audit will investigate whether hospitals billed for the 20% add-on Medicare payment for COVID-19 discharges correctly, OIG's work plan now states. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 03 Sep 2020
Healthcare Still Waiting on $121B in COVID-19 Financial Relief

Roughly 71% of the $412B in COVID-19 financial relief earmarked for healthcare has been disbursed or committed, the Committee for a Responsible Federal Budget found. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 02 Sep 2020
Home Health Payments Much Lower Than Expected Under New Model

Implementation of the Patient-Driven Groupings Model has shortchanged home health providers by about $1.3 billion so far in 2020, a new analysis shows. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 01 Sep 2020
2021 CPT Code Set Simplifies E/M Coding, Adds COVID-19 Tests

The changes to the 2021 CPT code set represent the first major overhaul of office visit and outpatient E/M coding in more than 25 years, the American Medical Association said. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 01 Sep 2020
Providers Price Gouging Out-of-Network COVID-19 Tests, AHIP Says

A new report shows that provider prices for out-of-network COVID-19 tests far exceeded the average cost of in-network tests. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 27 Aug 2020
AHA Slams Big Pharma Over Efforts to Limit 340B Drug Discounts

The Association is expressing “profound concern” about new actions five pharmaceutical companies are taking to rein in 340B drug discounts. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 24 Aug 2020
Surprise Billing Price Controls Decreasing Care Quality in CA

A new report shows that California’s benchmark prices for surprise billing narrowed provider networks and incented provider consolidation, two trends that threaten quality of care. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 24 Aug 2020
Children’s Hospitals Get $1.4B in Coronavirus Relief Funds

HHS made another round of targeted coronavirus relief funds, with the most recent going to almost 80 freestanding children’s hospitals impacted by COVID-19. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 19 Aug 2020
FAH Asks Congress to Delay Recoupment of Advance Medicare Payments

The group also urged Congress to reduce the amount of Medicare payments taken during recoupment and waive or decrease the interest rate on the advance or accelerated reimbursements. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 18 Aug 2020
HCCI: Physician Prices 122% of Medicare Rates on Average

A new HCCI analysis found that physician prices are higher than Medicare rates in most areas, but there is significant variation based on the area. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 13 Aug 2020
Providers Want Budget Neutrality Waived for E/M Payment Changes

Proposed E/M payment increases could result in damaging cuts for other Medicare Physician Fee Schedule services unless Congress waives budget neutrality in the wake COVID-19, providers say. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 12 Aug 2020
AMA Announces New CPT Codes for Coronavirus Testing

Four new CPT codes for coronavirus testing, including through antibody tests, will enable providers to report more laboratory testing of the novel coronavirus on medical claims. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 11 Aug 2020
Medicaid Enrollment Grew by 2.3M People at Start of the Pandemic

Job losses from the COVID-19 pandemic are leading to major insurance coverage disruptions, with major increases in Medicaid enrollment already evident in some states, a new study shows. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 10 Aug 2020
CMS Provides Medicare Wage Index Data for Reclassification

The agency released Medicare wage index data early so hospitals can decide whether they need to apply for reclassification before the Sept. 1 deadline. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 06 Aug 2020
Provider Relief Fund Deadline Extended for Medicaid Providers

Medicaid providers now have until Aug. 28th to apply for $15B in Phase 2 general distribution payments from the Provider Relief Fund, HHS recently announced. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 05 Aug 2020
CMS Resumes RAC Audits, Other Medical Review Activities

RAC audits and other medical review activities put on pause because of COVID-19 restarted August 3rd to the dismay of hospitals still struggling with the pandemic. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 04 Aug 2020
Hospitals Lose Case Challenging 340B Hospital Payment Reduction

An appeals court upheld a nearly 30% cut to 340B hospital payments despite arguments from industry groups that the reduction is unlawful. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 03 Aug 2020
CMS Pays for Coronavirus Counseling, Other COVID-19 Billing Updates

CMS recently announced provider reimbursement for self-isolation and other coronavirus counseling and updated FAQs on COVID-19 billing for remote services and coronavirus testing. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
Answer 30 Jul 2020
In the Final Hours, Providers Prepare for Repayment of Medicare Loans

Starting on or near Aug. 1, providers will have to start repaying over $100 billion in Medicare loans taken out at the start of the COVID-19 pandemic despite ongoing financial hardship. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 30 Jul 2020
Medicare Payments Top $2.8B for COVID-19 Hospitalizations, So Far

That number breaks down to over $25K in average Medicare payment per fee-for-service COVID-19 hospitalization, CMS reported. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 29 Jul 2020
AHA, AAMC Want Rehearing for Hospital Site-Neutral Payment Case

The industry groups intend for the rehearing to overturn a recent court decision ruling in favor of site-neutral payments for off-campus provider-based departments. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 28 Jul 2020
Medical Billing Mistakes for Malnutrition Led to $1B in Overpayments

OIG uncovered persistent medical billing errors involving the coding of severe malnutrition diagnosis codes on inpatient hospital claims from FY 2016-17, most of which resulted in overpayment. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 22 Jul 2020
Estimate Shows Uninsured Population Rising by 2.9M By End of 2020

With over 10M people projected to lose employer-sponsored health coverage because of the pandemic, the Urban Institute expects the uninsured population to grow by 10% through the end of the year. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 21 Jul 2020
CMS to Assess Telehealth Reimbursement Rates Post-Pandemic

In a blog post, CMS Administrator Seema Verma said the agency needs to assess telehealth reimbursement rates considering such significant uptake of virtual care during the COVID-19 pandemic. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 16 Jul 2020
Hospital Exec, Others Charged in $1.4B Rural Hospital Fraud Scheme

Ten individuals have been charged with a rural hospital fraud scheme that used financially distressed hospitals to fraudulently bill private payers for expensive laboratory tests. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 10 Jul 2020
TX Hospitals to Receive $1B Boost in Medicaid Reimbursement

The state’s governor secured the Medicaid reimbursement for the Uniform Hospital Rate Increase Program, which aims to reduce the Medicaid shortfall for Texas hospitals. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 09 Jul 2020
98% of Eligible Clinicians Avoided a MIPS Penalty in 2018

Nearly all eligible clinicians avoiding a MIPS penalty earned a positive adjustment, with a higher portion also receiving special scoring for MIPS APM participation, CMS reports. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 08 Jul 2020
Telehealth Billing Increased 8,336% from April 2019 to April 2020

Providers increasingly engaged with telehealth billing as the pandemic took hold, with telehealth claim lines growing from 0.15% of medical claim lines in April 2019 to 13.00% in April 2020. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 06 Jul 2020
Key COVID-19 Claim Denial Trends Arising from the CARES Act

Medical billing provisions in the CARES Act have led to an uptick in mispayments and claim denials that will need to be addressed by providers to ensure accurate reimbursement and compliant patient billing. Continue Reading
By
- XIFIN
News 03 Jul 2020
HHS Reduces Medicare Appeals Backlog by 43%

HHS is ahead of schedule for eliminating the Medicare appeals backlog, with a recent 43% reduction leaving just under 243K appeals still pending by the end of the second quarter of 2020. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 01 Jul 2020
AHA Projects $323B in COVID-19 Hospital Financial Losses in 2020

Updated data from the AHA indicates that hospital financial losses will grow by a minimum of $120.5B from July 2020 through December 2020, adding to the $202.6B in losses from earlier this year. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 30 Jun 2020
Primary Care Practices to Take $15B Hit from Early COVID-19 Response

A new study estimates that primary care practices will lose over $65K in revenue per full-time physician after drastic declines in office visits and payments from March to May 2020. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 29 Jun 2020
New CPT Code Expands COVID-19 Coding, Billing to Antigen Tests

The AMA’s new Category I CPT code will allow for COVID-19 coding and billing of antigen tests performed on patients suspected of being infected by the novel coronavirus. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 26 Jun 2020
Prior Authorization Burden Continues to Rise, Physicians Report

86% of practicing physicians said the prior authorization burden increased over the last five years despite efforts from the AMA and policymakers to streamline the process. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 22 Jun 2020
FAH Wants More Time, Lower Rates on Advance Medicare Payments

Hospitals should have at least until 2021 to repay Medicare payments advanced by CMS during the COVID-19 pandemic, the group says. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 16 Jun 2020
Skilled Nursing Facilities Facing a Financial Crisis from COVID-19

Deemed the epicenter of COVID-19 deaths by many, skilled nursing facilities and other nursing home providers are now on the verge of collapsing without financial help, industry leaders say. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 11 Jun 2020
Providers Want Equal Telehealth Reimbursement Beyond COVID-19

With telehealth reimbursement flexibilities set to expire following the public health emergency period, providers are calling on HHS and policymakers to continue payment parity beyond COVID-19. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 08 Jun 2020
AHA Asks for Another $50B in Coronavirus Relief for Hospitals

The association urged HHS to distribute $30B in additional coronavirus to relief to all hospitals, as well as special disbursements to hospitals in COVID-19 hotspots and those that treat more Medicaid patients. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 05 Jun 2020
Appeals Court Nixes Fraud Case Against Baylor Scott & White Health

The court affirmed a district court’s decision to dismiss a False Claims Act lawsuit alleging the Texas hospital system of billing Medicare using inflated codes. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 03 Jun 2020
Hospital Volume Recovery Sluggish Despite More Outpatient Visits

Driven by an uptick in outpatient visits, hospital volume is rebounding from the COVID-19 pandemic. But volumes are still well off 2019 levels as patients continue to avoid inpatient and ED care. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 02 Jun 2020
Out-of-Network Bills Common for Some Pathologists, Other Specialists

Less than half of specialists bill out of network, but some of those who engage in out-of-network billing do so more than 90 percent of the time, new research shows. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 01 Jun 2020
CMS Issues COVID-19 Billing Updates for Hospitals, Alternate Sites

New COVID-19 billing guidance from CMS clarifies reimbursement and coding policies for hospitals treating COVID-19 patients and alternate care sites created by hospitals during the pandemic. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 29 May 2020
HHS Gives $4.9B to Skilled Nursing Facilities Impacted by COVID-19

The funds will help skilled nursing facilities to offset significant expenses and lost revenues attributable to COVID-19, but more is needed to support long-term care, providers said. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 28 May 2020
1 in 5 Hospital Execs Expect Revenue Declines of Over 30% in 2020

Nearly all hospital executives in a recent survey anticipate their revenues to be lower at the end of 2020 as a result of COVID-19, but the pandemic could also spur more telehealth and M&A. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 14 May 2020
Hospital Payer Mix Influenced Size of Coronavirus Relief Funding

The size of coronavirus relief funding depended largely on a hospital’s payer mix, with hospitals relying on private payer revenue receiving 2x as much, KFF reported. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 14 May 2020
Small Practices Benefit Less from Medicare’s Care Management Codes

Large practices and practices other than a beneficiary’s assigned PCP are using Medicare’s care management codes more frequently, suggesting that the codes are not supporting primary care as expected. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 04 May 2020
HHS Gives $22B to Hospitals in COVID-19 Hotspots, Rural Areas

Rural hospitals and hospitals with high COVID-19 admissions will be receiving emergency payments from HHS to combat the novel coronavirus. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 27 Apr 2020
CMS Ends Advance Payments for Physicians, Other Part B Providers

The federal agency is also reevaluating the amounts paid under the Accelerated Payment Program, a similar advance payment initiative for hospitals during emergencies. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 27 Apr 2020
Coronavirus Healthcare Costs Could Total Up To $654B, Study Finds

A new study shows that coronavirus healthcare costs could tally up to $654B if 80% of the population becomes infected under herd immunity and other containment strategies. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 27 Apr 2020
Mitigating the Risk of Uncompensated Care to the Revenue Cycle

Uncompensated care remains a growing problem for healthcare providers, but scanning the entire revenue cycle can help find missing coverage quickly. Continue Reading
By
- Experian Health
News 24 Apr 2020
Studies Examine Surprise Billing for Ambulance Rides, ASC Visits

71% of ground and air ambulance rides involved potential surprising billing, while a separate study found a significantly lower rate among ASC visits. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
Answer 17 Apr 2020
What Providers Need to Know About COVID-19 Coding and Billing

The healthcare system is facing an unprecedented crisis, but accurate COVID-19 coding and billing can help providers weather the storm and prepare for future outbreaks. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 13 Apr 2020
3 Key Activities to Prevent Denied Claims in 2020

A three-pronged approach to denials management can help healthcare providers reduce lost revenue over the coming year. Continue Reading
By
- Experian Health
News 08 Apr 2020
CMS Pays Out $34B in Advance Medicare Reimbursement to Providers

The advance Medicare reimbursement will aid providers struggling to stay afloat during the COVID-19 crisis but will need to be paid back to CMS. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 08 Apr 2020
Hospital Reimbursement for Uninsured COVID-19 Cases May Total $42B

Hospital reimbursement for uninsured COVID-19 hospitalizations will range from nearly $14B to $42B, accounting for a significant portion of the $100B slated for hospitals in the CARES Act. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 06 Apr 2020
Hospital Stimulus Funds to Pay for Uninsured COVID-19 Treatment

Part of the $100 billion in hospital stimulus funds will go to paying providers Medicare rates for COVID-19 treatment for uninsured patients, the HHS Secretary said Friday. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 02 Apr 2020
AHA Asks for an Immediate $25K Per Hospital Bed to Combat COVID-19

Hospitals in COVID-19 hot spots would get $30k per bed from their MAC, according to the AHA’s plan to immediately distribute funds from the coronavirus stimulus package. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 30 Mar 2020
CMS Offers Upfront Medicare Reimbursement During COVID-19 Pandemic

The agency announced the expansion of its Accelerated and Advanced Payment Program for providers receiving Medicare reimbursement amidst the COVID-19 pandemic. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 30 Mar 2020
Hospitals to Lose $1K Per COVID-19 Case Despite Medicare Rate Bump

Even with the 20% Medicare rate increase in the stimulus package, hospitals are set to lose about $1,200 per COVID-19 hospitalization, a new analysis shows. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
Answer 24 Mar 2020
Documentation to Ease Medical Billing Issues Due to COVID-19

A healthcare lawyer advises providers to thoroughly document care delivery to prevent medical billing and payment issues likely to arise from the COVID-19 pandemic. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 16 Mar 2020
MedPAC Suggests No Medicare Payment Increase for Physicians

The commission also recommended in its annual March report a 2% increase in Medicare payment for hospital services. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 16 Mar 2020
CMS Releases Medicare Reimbursement Details for COVID-19 Tests

Medicare reimbursement for COVID-19 tests will be about $36 for the CDC test and $51 for those created in house or by other entities. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 11 Mar 2020
No Reimbursement Impedes Social Determinants of Health Progress

A lack of direct reimbursement was the top factor standing in the way of social determinants of health progress, followed by inability to demonstrate ROI, a survey shows. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 04 Mar 2020
42% of Anesthesiologists Had Contracts Terminated in Last 6 Months

A survey of anesthesiologists shows that insurers are abruptly terminating physician contracts, forcing many of the specialists out of network. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 02 Mar 2020
Number of Medicare-Dependent Hospitals Falls by 28%

The number of Medicare-dependent hospitals (MDHs) that received additional payments also declined by 15% from 2011 to 2017, GAO found. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 24 Feb 2020
Inpatient No Longer King as Hospital Outpatient Revenue Grows

The gap between inpatient and hospital outpatient revenue narrowed, with outpatient dollars accounting for nearly half of total hospital revenue by 2018, a new report shows. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 20 Feb 2020
Claims Reimbursement Changes Notably Reduce Low-Value Care

Recommendations alone may be insufficient for reducing low-value care services, but have a greater impact when reinforced by changes to claims reimbursement. Continue Reading
By
- Samantha McGrail
News 20 Feb 2020
Patient-Driven Payment Model Reimbursement Exceeds CMS Prediction

After the Patient-Driven Payment Model closed its first billing cycle, rates exceeded CMS’ predictions for skilled nursing facilities. Continue Reading
By
- Emily Sokol, MPH
News 19 Feb 2020
Medicare Payments Unfair to Providers Treating Vulnerable Patients

Providers, hospitals, and Medicare Advantage plans treating the most vulnerable populations are at risk for inequitable Medicare payments given the program’s current payment system. Continue Reading
By
- Emily Sokol, MPH
News 18 Feb 2020
Emergency Medicine’s Ongoing Battle for Equitable Reimbursement

Emergency departments have a responsibility to treat all patients, but many fail to understand the business challenges of operating under this unique model. Continue Reading
By
- Brault Practice Solutions
News 13 Feb 2020
20% of Elective Surgery Patients Receive a Surprise Medical Bill

A substantial portion of operations ended in an out-of-network billing, leading to potential surprise medical bills totaling thousands of dollars, a study found. Continue Reading
By
- Samantha McGrail
News 10 Feb 2020
5 Key Ways to Ensure Hospital Compliance Program Consistency

Implementing a consistent hospital compliance program is key to cultivating a culture of compliance that minimizes revenue risks, so providers can focus on high-value care. Continue Reading
By
- 3M
News 10 Feb 2020
Hospitals Closed 2019 with An Uptick in Volume, Patient Revenue

Hospitals saw a boost in hospital profitability in December 2019, with volume and patient revenue rising despite a slight increase in supply expense. Continue Reading
By
- Samantha McGrail
News 04 Feb 2020
Overcoming Growing Pains Through Effective Hospital Compliance

Hospitals and health systems are increasingly expanding into the ambulatory space. While positive, this growth does necessitate a shift in hospital compliance. Continue Reading
By
- 3M
News 30 Jan 2020
CO Healthcare Costs Keep Climbing Due to Hospital Cost-Shifting

A new report from the state shows that hospital cost-shifting has continued to increase healthcare costs despite regulations intended to stymie the practice. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial
News 29 Jan 2020
Medicare Overpaid Surgeons by $2.6B for Postoperative Care

A study shows that Medicare reimbursed surgeons for postoperative care visits for nearly all minor surgical procedures despite only 4% resulting in postoperative care. Continue Reading
By
- Samantha McGrail
News 27 Jan 2020
3 Components of a Proactive Hospital Compliance Program

Internal and external audits, as well as education and training, are all ways hospitals can install a proactive compliance program. Continue Reading
By
- 3M
News 24 Jan 2020
Prior Authorization Costs Rise as Electronic Adoption Remains Low

According to CAQH, manual prior authorization costs increased by $4.31 from 2018 to 2019, making it the costliest administrative transaction for providers. Continue Reading
By
- Jacqueline LaPointe, Director of Editorial