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Reimbursement

January 6, 2020
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Evolving toward engagement: The recent history of patient segmentation

Patient segmentation — classifying people according to their ability and propensity to pay their medical bills — has been around for a long time. In recent decades, technology that determines these classifications and updates the resulting profile has also improved the accuracy of these portraits of patients’ financial footing. Health system use of that information, however, hasn’t evolved at the same pace.

January 6, 2020
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'Medicare for All': What would it really mean for healthcare stakeholders?

In the spotlight as the 2020 presidential election cycle approaches, “Medicare for All” (M4A) is one of the most defining and contentious issues in politics. According to an August 2018 Reuters/Ipsos poll, 70% of people surveyed support M4A. Another survey indicates the underlying reason for Americans’ interest in healthcare reform: 77% are concerned that rising healthcare costs will cause significant and lasting damage to the U.S. economy, and 45% believe a major health event could leave them bankrupt, according to a 2019 Westhealth/Gallup survey. 

 

 

Categories: OP-ED Reimbursement
December 10, 2019
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How To Identify Patient Retention And Leakage ‘Forks In The Road’ And Choose The Right Path

Patient leakage from a health system network is an emerging critical issue facing healthcare leaders. As Medicare and Medicaid reimbursements continue to negatively affect operating margins for even high-performing health systems, competition for privately insured patients is increasing.

Categories: Reimbursement
October 29, 2019
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Utility of Point-of-Care Ultrasound Across Clinical Applications Spurs Continued Growth

With the miniaturization of technology, improved ease of use, lower system cost, increased portability, and greater access to training, the appeal of ultrasound continues to expand in point-of-care (POC) markets. Estimated growth in the POC ultrasound (POCUS) market is expected to exceed $3 billion globally by 2025,[1,2] up from $1.3 billion in 2018.

Categories: Reimbursement
October 29, 2019
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In the wake of recent news, providers should examine their patient collection practices to avoid pitfalls

Intermountain Healthcare Executive Vice President and CFO Bert Zimmerli recalls a conversation 15 years ago with a patient advocate about the challenges facing many patients with healthcare-related debt.

 “Most of them are overwhelmed,” the advocate told Zimmerli. “Some are clinically depressed. You would see a stack of bills on the table that they haven’t even opened because they know they can’t pay them."

Categories: Reimbursement
August 26, 2019
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Congress: Advance a Fair Out-of-Network Solution

ASPS Advocacy Summit attendees headed to the Hill in the midst of a heated congressional debate over how to address unanticipated medical expenses. Although all parties are committed to removing patients from billing disputes between providers and carriers, little consensus exists on how to execute that goal. Insurance companies, patient advocacy groups, the physician community, labor unions and others have all been lobbying for their own approaches.

Categories: Reimbursement
August 26, 2019
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One health system’s experience relevant to proposed price transparency rule

CMS recently proposed a rule requiring hospitals to disclose the amount that patients would pay for services before they receive care. The rule is part of the Trump administration’s ongoing effort to lower health care costs and increase transparency.

 

August 26, 2019
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7 Things You Need to Know Now About Appropriate Use and Clinical Decision Support

For physicians who treat Medicare patients, everything changes next New Year’s Day. That’s when real consequences begin to befall those who order advanced imaging—CT, MRI or PET scans—without first consulting appropriate use criteria (AUC). They’ll need to show they did so by using a CMS-qualified clinical decision support mechanism (qCDSM).

Categories: Reimbursement
June 27, 2019
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Why is (almost) no one billing for remote patient monitoring?

Did you know that there are eight CPT codes that could generate potentially millions of dollars of annual revenue for your organization without significantly changing provider workflows — and that would also help you deliver better care? The Centers for Medicare and Medicaid Services’ (CMS) remote patient monitoring (RPM) codes are here: however, very few organizations seem to know about them, and even fewer are taking advantage of them. 

June 27, 2019
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When Medicare Fraud Has Fatal Consequences

Medicare fraud is a victimless crime, right? Unfortunately, some folks still see things that way. That attitude may account for why Medicare fraud costs taxpayers tens of billions of dollars each year. Who says? The FBI! Obviously Medicare fraud isn’t a victimless crime since those Medicare dollars come from taxpayers.

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