As government and private payors shift their reimbursement strategies from fee-for-service to value-based contracting, hospitals are gradually becoming more on the hook, financially, for meeting certain quality and cost targets.
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 created the Recovery Audit Contractor Program to reduce improper Medicare payments, and since its inception, the program has collected more than $2.5 billion in overpayments, as of August 2012.
FEWER PHYSICIANS are willing to accept Medicaid patients today, as the reimbursement rates continue to decline. State and federal policies are attempting to remedy the problem with additional funding, particularly for primary care. – See more at: http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/temporary-medicaid-fee-hike-could-come-back-haunt-plans#sthash.BnJ1MKFC.dpuf
I need to correct an earlier post and apologize for misleading you.
This week I declared “39 percent of payers report they won’t be ready for ICD-10 in 2014.” This was based upon a HealthEdge news statement that teased their State of the Payor survey. What led me to write the 39 percent headline was this nugget of information, simple math and deductive reasoning:
“Only 61 percent of payors believe they will be ready to meet the new ICD-10 compliance deadline”
The Supreme Court upholds the vast majority of the Affordable Care Act, but its decision raises new questions about Medicaid expansion
While the Supreme Court last month closed the door on a major constitutional question, the justices appear to have created a new era of uncertainty surrounding a key provision of health care reform.
As healthcare organizations prepare for the ICD-10 conversion, everyone knows there will be challenges. And while much of the focus has been on the difficulties of hands-on implementation, financial managers are not likely to make it through unscathed.
The legal intricacies of today’s 5-4 decision by the Supreme Court to uphold key provisions of the Affordable Care Act will be parsed for weeks, months and probably years, and will extend far beyond health care. But for hospital executives wondering what it all means for their operations, there are two key pieces emerging at the moment— while the Court upheld the individual mandate as a tax, it may make it difficult for the federal government to withhold existing Medicaid funds from states that refuse to participate in the law’s Medicaid expansion. So while millions of additional paying customers are expected to enter the health care system via the mandate, longstanding concerns about uncompensated care will remain an issue for hospital balance sheets.
For the past two weeks, people following healthcare reform have waited eagerly for the Supreme Court to issue its decision on the constitutionality of the Patient Protection and Affordable Care Act. It hasn’t happened yet, and everyone with an interest in the nation’s healthcare system continues to wait and see what the Court’s ruling will be.