Payment Reimbursement and Managed Care

Earning a 4-start patient-experience rating takes dedication

Main article: Why optimizing the patient experience should be on every C-suite leader’s radar Under Maryland’s hospital rate-setting system, 1% of hospital payment from all payers is based on an organization’s performance on the HCAHPS inpatient survey. “It can be millions of dollars for organizations that can be lost or gained,” says Lisa Allen, PhD,…

Laura Ramos Hegwer June 11, 2019

Why optimizing the patient experience should be on every C-suite leader’s radar

Jason Wolf, president and CEO of The Beryl Institute, knows from personal experience how easily a healthcare organization can lose a customer. A few years ago, his wife was mistakenly billed for a $25 copay that she already paid, and then the account was fast-tracked into collections. Despite receiving excellent clinical care, his wife vowed…

Laura Ramos Hegwer June 11, 2019

Timing, details unclear for executive order on price transparency

An expected executive order on healthcare price transparency continues to change, even as its release has been delayed, say policy watchers.

Rich Daly June 11, 2019

CMS cardiac procedure changes could cost hospital cardiac programs $700 million

In a move that could have profound financial implications for hospitals, the 2019 Outpatient Prospective Payment System final rule adds 17 cardiac procedures to the list of procedures approved by CMS to be performed in ambulatory surgery centers.

Ronald Hirsch, MD, FACP, CHCQM June 11, 2019

How physician-finance partnerships pave the way to higher-value care

Physician leaders and finance leaders can use their respective strengths to complement each other and help each other thrive in a value-based environment.

Douglas Ardoin Jr., MD, MBA June 11, 2019

A caveat: A cardiac procedure performed in an ASC may cost a Medicare beneficiary more

For Medicare beneficiaries who are considering out-of-pocket costs for the cardiac services that CMS has approved to be performed in ambulatory surgery centers (ASCs), hospitals could be a more attractive site of service.

Ronald Hirsch, MD, FACP, CHCQM June 10, 2019

Inconsistent address data could delay Medicare payments

One health system found in its Medicare enrollment system that addresses were missing for new facilities. Another found addresses still listed for a demolished facility.

Rich Daly June 7, 2019

Mandates related to pricing, Medicare participation lead hospital concerns over healthcare IT proposed rules

Hospitals supported many of the transparency goals of two proposed healthcare IT rules, but two areas drew sharp concerns.

Rich Daly June 5, 2019

Analysis: Movement seen on overdue Medicare Discharge Planning Rule

The Medicare Discharge Planning Rule, which was sent to the Office of Management and Budget last week, would require hospitals to provide patients with data to help guide their selection of a post-acute care provider.

Chad Mulvany, FHFMA May 31, 2019

Analysis: Why some participants are likely to leave the Oncology Care Model

Some participants in CMS’s Oncology Care Model may exit the program instead of being transitioned into a two-sided risk model.

Chad Mulvany, FHFMA May 31, 2019
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