The vital relationship between MDs and clinical documentation integrity
High-quality clinical documentation is vital for creating a complete picture of a patient’s health and medical history. Accurate records of diagnoses, medications, tests, treatments and other elements of a patient’s care are crucial in creating the most effective care plan leading to positive outcomes. The quality of a physician’s clinical documentation can also impact payer…
For providers, application of the 2-midnight rule to Medicare Advantage appears to bring a revenue influx
Hospitals appear to have gained a significant, albeit likely short-term, revenue boost from CMS’s 2023 directive to Medicare Advantage (MA) health plans regarding the two-midnight rule. The rule first was instituted in 2013 for Medicare fee-for-service (FFS), requiring the program to cover hospital stays as inpatient admissions if the admitting physician expects the stay to…
A new DOJ task force is the latest example of intensified federal oversight of healthcare antitrust issues
A new task force at the U.S. Department of Justice (DOJ) is likely to bring additional scrutiny on whether healthcare transactions adversely affect competition. The department’s Antitrust Division announced the formation of a group to “consider widespread competition concerns shared by patients, healthcare professionals, businesses and entrepreneurs, including issues regarding payer-provider consolidation, serial acquisitions, labor…
340B providers are at a disadvantage after the latest court ruling on contract pharmacies
A decision issued by an appeals court represents the latest setback for 340B providers hoping to secure widespread access to price discounts on Medicare Part B drugs. The U.S. Court of Appeals for the District of Columbia Circuit on May 21 upheld a district-court ruling that drug manufacturers can impose restrictions on the 340B discounts…
Hospital payments have been substantially affected by the Change Healthcare cyberattack, report finds
Newly published data reflect the extent of the payment loss experienced by hospitals and health systems during the first month or so after the Change Healthcare cyberattack. A report (registration required) published in mid-May by Strata finds that gaps in expected revenue ranged from 16.5% to 17.9% per hospital for Q1. The insights were culled…
HHS issues regulations to strengthen anti-discriminatory protections in healthcare
Healthcare providers should be aware of the compliance requirements in sweeping new federal regulations intended to improve health equity and reduce healthcare disparities. An HHS final rule expands upon Affordable Care Act (ACA) Section 1557 language that has prohibited discrimination on the basis of characteristics such as race, color, national origin (including English proficiency), age,…
Ascension systems remain down after cyberattack
Executives with Ascension health system, St. Louis, are keeping in contact with leading law enforcement agencies and industry organizations as they work to restore systems that were shuttered by a cyberattack. The apparent ransomware attack has led to a shutdown of different systems that will last for an undetermined period of time. The attack also…
Bridging the gap: Integrating value-based care into revenue cycle management
The idea of value-based care (VBC) has existed for decades but only gained momentum since the 2017 implementation of the Merit-based Incentive Payment System (MIPS) and the Quality Payment Program (QPP). VBC incentivizes providers for quality outcomes, unlike fee-for-service models that reimburse providers for each service performed. The ultimate goal of VBC is to improve…
Annual report on Medicare financing could reduce the immediate impetus to address longstanding issues
New data on the state of Medicare funding show short-term improvement while keeping the stakes high for ensuing decades. The annual report from Medicare’s trustees shows the Hospital Insurance Trust Fund (i.e., Medicare Part A) has enough money to keep beneficiaries covered and providers paid through 2036. That’s an increase of five years from the…
Closures of Walmart’s health centers reflect the widespread financial constraints in U.S. healthcare
Beyond signaling a setback for retail-based healthcare disruptors, Walmart’s recent decision to close its health centers is symptomatic of issues hampering the nation’s ecosystem for primary care, industry analysts say. The retail behemoth announced April 30 it would be closing all 51 of its health centers across five states, along with its virtual-health service. Five…