The Centers for Medicare & Medicaid Services (CMS) recently published their 2,434-page fiscal year 2017 Hospital Inpatient Prospective Payment System (IPPS) Final Rule. The hospital community eagerly anticipated this new arrival, especially its expected changes to Medicare disproportionate share hospital (DSH) payments. To illustrate the potential impact of the 2017 IPPS rule, we’ve highlighted three [...]
Participating in the Olympic Games can create career-defining moments for elite athletes. Similarly, healthcare providers that participate in alternative (or “value-based”) payment models can yield desirable benefits for themselves and their patients. These models are intended to incentivize a greater continuity and coordination of care between providers, leading to better patient outcomes at lower costs. [...]
In January 2015, the Centers for Medicare & Medicaid Services (CMS) released an initiative to quickly move the Medicare payment system away from traditional fee-for-service reimbursements and toward those linked to value and quality – including alternative (or value-based) payment models. Most, if not all, healthcare providers are at least partially affected by these models. [...]
For many hospitals and facilities with large amounts of uninsured and Medicaid patient volume, Medicare disproportionate share hospital (DSH) payments have long been a vital and irreplaceable component of their overall reimbursement equation. While the Centers for Medicare & Medicaid Services (CMS) has been discussing potential changes to the Medicare DSH calculation methodology for several [...]
Nursing Home ACA PBJ Reporting is Getting Messier, But Here’s a Recipe for Success While peanut butter and jelly sandwiches are not mentioned in the Patient Protection and Affordable Care Act (ACA), almost everyone knows that individual and employer sponsored health insurance mandates are. However, many people often do not realize that many other healthcare [...]
Healthcare cost reports not only satisfy regulatory requirements, but they can also yield beneficial information to help healthcare providers increase transparency with patients. Watch Bart McCurley as he discusses three ways in which healthcare cost reports can provide greater organizational value.
As transparency becomes more important in the healthcare industry, consumers will pay more attention to provider ratings when deciding where to receive medical services. Watch Bryan Hall describe how hospitals can use rating systems to their advantage.
With the increased focus on quality in the healthcare industry, organizations that prioritize quality patient care can reap important financial benefits. Watch as Rodney Thornton discusses how quality can help physician practices increase revenue.
In response to rising demand and costs in the post-acute care market, the U.S. Department of Health and Human Services is exploring value-based payment options for post-acute care providers. Watch Jennifer Hamway as she explains the role of value-based payments in patient care.
Medical practices seek effective ways to prepare for the arrival of new patients receiving healthcare coverage through the Affordable Care Act’s (ACA’s) new Health Insurance Marketplaces and expanded Medicaid programs. Non-physician providers (NPPs), including nurse practitioners, nurse midwives, physician assistants, and physical therapists can provide much-needed support in this new healthcare era. However, for NPPs [...]
The adage “time is money” is particularly relevant when establishing a system to track physician productivity. Unfortunately, most practices use an outdated method that measures units, charges, and collections. These metrics do not accurately measure physician productivity because they are sensitive to modifiers, charge increases, payer mix, and changing reimbursement amounts. As a result, physician productivity [...]
When health maintenance organizations (HMOs) evolved into managed care organizations (MCOs) approximately two decades ago, there was a strong push for provider panels to accept only physicians who could practice cost-efficient medicine. These parameters meant choosing doctors who used minimal resources without compromising quality. This process, called “economic credentialing,” provoked vigorous debate and lawsuits. The disputes [...]
What are the secrets of running a top-performing physician practice? Luckily, that’s not classified information requiring a security clearance. Here are the six secrets to building a thriving medical practice. 1. Track Medical Practice Charges and Collections If a practice is expanding and fees are increasing, then charges should increase steadily over time. To evaluate charges [...]
Successful gardeners know that growing flavorful vegetables requires high attention to detail. Attention to detail is also necessary for a healthcare facility to maximize its collection rates. Planting the Seeds for Payment at Time of Medical Practice Service Planting the seeds for payment at the time of service (TOS) requires proper staff training on: understanding [...]
Just as we exhibit symptoms when we are sick, medical practices exhibit symptoms when they are not doing well. How do medical practices keep themselves healthy? They should conduct regular systems check-ups on the following aspects of their day-to-day operations: 1. Cash Receipts - Are all payments promptly collected and deposited into accounts? - What [...]
In today’s rapidly changing healthcare environment, many physicians are considering setting up a private practice. The most beneficial practice type depends on each physician’s professional goals, career path, and willingness to be involved in management decisions. Below is a list of the pro and cons for private practice and hospital employment that doctors should evaluate [...]
Many physicians see few advantages to remaining on an insurance company’s provider panel. Physicians are transitioning to out-of-network provider status primarily because of billing and payment difficulties. However, is the grass greener out of network? Medical Practice Risks to Being Out of Network Because out-of-network providers avoid contractual adjustments and in-network claims processing, they may [...]
As healthcare reimbursements decrease and patients incur greater responsibility for healthcare costs, medical practices must properly manage patient accounts receivable to maintain their cash flows. Many employers are moving away from traditional health insurance plans as employer insurance costs continue to rise. High-deductible health plans (HDHP) offer lower premiums to employers in exchange for higher [...]