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Reimbursement

April 12, 2021
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Better integration with primary care can help address the ongoing mental health and addiction crisis, report finds

Integrating primary care and behavioral healthcare can shore up the nation’s capacity to address the surging mental health crisis, according to a new report. Existing value-based payment structures can be deployed to promote the availability of high-quality behavioral healthcare.

April 12, 2021
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How has reduced reimbursement for acromioplasty impacted your patients and practice?

Although reduced reimbursement for acromioplasty has negatively impacted me financially, it has not impacted my patients. I still use the patient’s clinical history, symptoms and surgical findings to perform acromioplasty when I consider it to be helpful based on evidence-based medicine, logic and my experience. In 2012, code 29826 was changed to an add-on code and was reduced from 9.16 relative value units (RVUs) to 3 RVUS. That reduction in reimbursement had a moderate negative financial impact on my practice for Medicare patients.

Throwing away money
March 16, 2021
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CPT code blunders cost one radiology practice more than $20K per month, new analysis shows

Delays in adopting new current procedural terminology codes cost one academic radiology practice hundreds of thousands of dollars in revenue, according to a new analysis.

March 5, 2021
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Low-value care spending drops marginally, despite best efforts

Despite efforts to educate clinicians and increase payment revisions, little has changed in the amount spent on low-value healthcare for traditional fee-for-service Medicare patients.

March 5, 2021
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4 Ways To Keep Ahead Of Denials Amid The Pandemic

Understanding all that’s required to secure healthcare payment during a pandemic — especially for services related to COVID-19 — demanded that revenue cycle teams quickly refine denials management processes to protect their organization’s financial health. It also necessitated a spirit of patience and understanding toward payers, which faced a similar learning curve. 

Categories: Reimbursement
March 5, 2021
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Pandemic, changes in health care spur practice consolidation

Published literature has shown the postponement and cancellation of elective procedures during the COVID-19 pandemic had a substantial financial impact on orthopedic practices and hospitals. In a study in International Orthopaedics, Matthew J. Best, MD, and colleagues estimated hospital losses of $10.9 to $11.9 billion in reimbursement and $2.6 to $3.5 billion in net income due to canceled elective musculoskeletal surgery during 8 weeks of the COVID-19 pandemic.

December 7, 2020
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CMS drops final 2021 Physician Fee Schedule that includes ‘deeply troubling’ cuts to radiologists’ pay

The Centers for Medicare and Medicaid Services dropped its hotly anticipated final Physician Fee Schedule on Tuesday that includes significant compensation cuts for radiologists and other specialties.

Categories: Reimbursement
December 7, 2020
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CMS issues final rule on Stark Law

CMS has issued a final rule on the Medicare physician self-referral law (Stark Law) and anti-kickback rules that better integrate value-based care, and lessens regulatory burdens on physicians.

Categories: Reimbursement
Illustration of a money tree growing out of coins
September 25, 2020
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Despite the pandemic, hospitals continue to shift toward value-based payment

The COVID-19 pandemic has complicated the efforts of hospitals and health systems to succeed under risk-based payment models, but that hasn’t dampened some organizations’ pushes to increase their revenue from value-based payment (VBP). In response to the pandemic’s disruption in care for patients in VBP models, Medicare has offered providers wide latitude to help them avoid financial consequences during 2020.

Categories: Reimbursement
Monthly budgeting graphic
September 25, 2020
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Offering long-term payment plans to meet the financial needs of patients

As healthcare payment liability continues to shift to patients, it has become increasingly important for healthcare organizations to offer convenient and accessible patient payment options. Prior to COVID-19, the exponential growth of high deductible health plans along with rising consumerism drove the need for more flexible payment vehicles. While those drivers are still valid, the current public health crisis has made payment programs even more essential.

Categories: Reimbursement

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