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Reimbursement

March 28, 2022
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Keys to Maximizing Your Share of the Local Radiology Market

The pandemic was a significant challenge for many radiology practice groups. However, it also provided an opportunity for them to take an honest assessment of their operations and find ways to improve, innovate and maximize efficiencies to remain competitive and thrive in a post-pandemic climate. Radiology practice groups are seeing increased imaging demand as patients are catching up on missed care over the last two years. There are a few core questions practice leaders must ask themselves.

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March 2, 2022
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Four ways healthcare organizations can improve financial performance

Strong financial performance is essential for the success of healthcare organizations. To continue providing the best patient care while also improving financial performance, consider these four tactics.

February 11, 2022
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No Surprises Act: Expert insights to help doctors follow the law | American Medical Association

Implementation of the No Surprises Act, intended to protect patients from unexpected out-of-network medical expenses, will take a while. But there are things that doctors must know and do now to comply and be prepared as regulations are developed and put in place. 

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January 31, 2022
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Latest healthcare spending data paint a complicated picture of industry challenges and opportunities

Healthcare spending surged during the first year of the COVID-19 pandemic even as spending on direct care slowed significantly, according to new data. There are no easy solutions to make spending on hospital care more efficient within the current payment structure, a healthcare economist said. Public health should be a greater emphasis in healthcare spending policies, another expert said. Newly reported healthcare spending patterns from the first year of the COVID-19 pandemic reflect an industry trying to get its bearings amid both a public health emergency and daunting long-term trends. 

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January 5, 2022
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New surprise billing regulations: How providers should be preparing to fulfill the pending requirement about good-faith estimates

Providers have had a mere three months to implement the processes needed to comply with a new requirement to furnish uninsured patients with good-faith price estimates ahead of services. 

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December 6, 2021
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Healthcare industry leaders share ideas with CMMI for improving value-based payment models, with benchmarking a top concern

During a recent call with healthcare stakeholders, leaders with the Center for Medicare & Medicaid Innovation heard various ideas for improving value-based payment models. CMMI conducted the November call to get a better sense of how it can accommodate stakeholders as it seeks to implement a revamped vision for VBP models. 

Categories: Reimbursement
December 6, 2021
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New Exa Platform Functionality Automates Decision Support, Insurance-Related Tasks for Enhanced Productivity and Profitability

Konica Minolta Healthcare Americas, Inc., announced today new features and functionality for the Exa ® Platform that automate common clinical and administrative tasks. These new capabilities assist use of Appropriate Use Criteria (AUC) for advanced diagnostic imaging, supporting a Centers for Medicaid and Medicare Services (CMS) mandate, and eliminate inefficiencies in determining patient insurance eligibility and co-pay responsibility.

December 6, 2021
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2022 Physician Fee Schedule prompts praise, but also fear of ‘financial peril’

The CMS final rule regarding physician payment, clinical labor prices, critical care services and telehealth services for fiscal year 2022 has drawn mixed reactions from medical groups. Some of the rule’s components exacerbate concerns brought on by the COVID-19 pandemic while others alleviate them, the groups said.

Categories: 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.

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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.

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