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Reimbursement

October 7, 2021
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The stakes are only growing in the effort to improve the cost effectiveness of health, CMMI’s Elizabeth Fowler says

Elizabeth Fowler, head of the Center for Medicare & Medicaid Innovation, spoke to an HFMA audience about the importance of efforts at the federal level and beyond to improve the cost effectiveness of health. Stakeholders can expect CMMI to develop models to reduce low-value care. A greater number of mandatory models is likely, and CMMI recognizes the need to better support participants. The task of making the U.S. healthcare system more cost-effective is becoming increasingly urgent, the head of the Center for Medicare & Medicaid Innovation (CMMI) told an HFMA audience.

hour glass with money on the table
September 10, 2021
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Be Aware: Some Providers Are Getting Shortchanged on COVID-19 Vaccine Reimbursements

First the urgent care industry saw itself cut out of the distribution chain for COVID-19 testing supplies. Next, it saw vaccines go preferentially to go health systems, public health organizations, and chain drugstores and big box stores. Now, as it continues to come back from those oversights, there are reports that UnitedHealth Group is undercutting the reimbursement rate set by the Centers for Medicare and Medicaid Services for immunizing patients against SARS-CoV-2.

Medical claim denied graphic
August 2, 2021
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Healthcare News of Note: National index shows denials are up 11% since the onset of COVID-19

The Change Healthcare 2020 Revenue Cycle Denials Index states that the average denials rate is up 23% since 2016, topping 11.1% of claims denied upon initial submission through the third quarter of 2020. 

Categories: Reimbursement
July 13, 2021
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How to ensure a positive patient financial experience

When it comes to improving the patient experience, providers tend to focus on the front-end experience. Whether it’s enhancing point-of-service interactions or clinical touchpoints in the patient journey, these aspects of patient experience are crucial. But they’re not the only ones impacting net promotor scores (NPS) and HCAHPS results.

doctor with money and calculator
July 13, 2021
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Why fee-for-service can have a place in a reimagined healthcare system, but not as the primary mode of payment

Fee-for-service has been coming under increasing scrutiny in recent years, but the healthcare industry shouldn’t dismiss it as a mode of payment altogether.

Person pressing a floating trash can icon
June 8, 2021
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Weeding out waste: Policy workshop examines how the healthcare industry can finance a better model

As the U.S. healthcare industry makes an increasingly concerted effort to move to population health management, the key question is how to pay for such a transformation.

 

Categories: Reimbursement
graphic with money, calculator and stethiscope
April 28, 2021
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Congress averts Medicare cuts set to hit radiologists, sending final bill to president

The U.S. House finalized legislation in a 384-38 vote Tuesday, averting 2% Medicare pay cuts set to hit radiologists and other physicians. Following passage in the Senate, President Joe Biden signed the bill on Wednesday, April 14.

Categories: 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.

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