How CMS Leveled the Playing Field for Hospital Readmission Penalties
A new rule finalized by CMS acknowledges that charging hospitals with higher percentages of dual eligibles the same readmission penalties as hospitals with fewer of these patients. The proposed penalty adjustment will reflect the challenges facing each hospital's populations.
Why Horizon BCBSNJ Likes Episode-of-Care Payments
Horizon Blue Cross Blue Shield of New Jersey’s episode-of-care program, believed to be the largest such program in the country, rewards physicians for successes but does not subject them to penalties. Horizon says that this arrangement creates better foundations for payer/provider relationships to move toward shared risk over time.
The Move to Office-Based Services Not Yet Showing Impact
Although commercial health plans have tried to equalize payments between hospital and office-based settings, hospital payments still remain higher and share of procedures by site have remained consistent.
Why Health Plans Are Easing Preauthorization
In an attempt to build cooperative working relationships with physicians, some health plans are trying to reduce the burden of preauthorization.
The Future of Value
The move toward value remains a constant although the future of health care is uncertain.
Maximizing Out-of-Network Payment for Patients with ACA Exchange Products
Hospitals should take steps to ensure the receive the full payment to which they are entitled for out-of-network patients enrolled in health plans purchased on the Affordable Care Act insurance exchange.
Ask the Experts: Payer Payments
Are there any benchmarks for how quickly payers should get back to us on claims and denials?
The Self-Pay Compliance Problem: Payment Security
David King discusses the hospital’s role as “merchant” when patients use credit cards to pay for their care.
Ask the Experts: Payment Adjustments and Meaningful Use
Our organization has not made any effort to attest to meaningful use, and we have received a notice from CMS with attestation deadline dates in February 2017. Will we experience payment adjustments in the upcoming fiscal year? How can I confirm our status?
Making ACO Participation Pay Off
Delaware Valley ACO’s emphasis on improving care while lowering costs has proven effective, demonstrated by an increase in members from 5,000 to 200,000 in three years.