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Finance

 

An ever-changing world of reimbursement can be frustrating for those involved in revenue cycle management (RCM). Being too set in your ways to change, however, is one of the most common strategic mistakes seen by Nicole Rogas, MBA, senior vice president of sales at Experian Health.

Whether Republicans’ version of an Affordable Care Act repeal-and-replace bill looks like the House-passed American Health Care Act (AHCA) or the Senate’s Better Care Reconciliation Act (BCRA), it would have a negative impact on the credit ratings of nonprofit hospitals, according to Fitch Ratings.

Transitioning to value-based care and taking on risk is often cited as one of the drivers of the consolidation trend throughout healthcare. Some systems, however, are beginning to look at partnerships more “holistically,” according to Kaufman Hall managing director Anu Singh, MBA, by pursuing creative affiliations to enhance their capabilities rather than a merger or acquisition.

In a year with new payment tracks for Medicare, additional bumps in the road on the path to value-based care and—potentially—an overhaul of health insurance coverage coming through Congress, what are healthcare finance leaders going to be focused on at this year’s conference?

Predictive modeling has been shown to help providers assess patient risk for a variety of conditions—which is how the vast majority of hospitals and health systems have been utilizing it.

 

Recent Headlines

Top 10 MACRA trends challenging providers

The need for new or upgraded software, provider consolidation and hiring consultants are some of top trends practices will need to contend with as they prepare for the new payment tracks in the Medicare Access and CHIP Reauthorization Act (MACRA).

Aetna completely out of ACA exchanges for 2018

Making good on promises made by its CEO earlier this year, Aetna confirmed it will not offer policies on the Affordable Care Act (ACA) exchanges in any market for 2018. 

Clinicians can check 2017 MIPS participation status online

CMS has opened up a new online tool for clinicians to check whether they should participate in the new Merit-based Incentive Payment System (MIPS) for 2017.

Anthem wants 60 more days to fight Cigna’s exit from merger

Anthem has requested more time from a Delaware court to salvage its $54 billion merger with Cigna, asking for a 60-day extension of a temporary injunction to block its would-be partner from opting out of the deal. 

Billing patients at chargemaster rates may be illegal

Charging patients at the list prices for procedures and services set by the hospital chargemaster isn’t allowed under contract law, according to a study published in American Journal of Managed Care.

Siemens Healthineers looking at several separation options

Siemens is moving ahead with the planned split of its healthcare division, Siemens Healthineers, with CFO Ralf Thomas listing three options for the $15 billion business: a spinoff, an initial public offering or a reverse merger with a public company.

Anthem wants Supreme Court to review blocked Cigna deal

Anthem is taking its blocked $54 billion acquisition of Cigna to the U.S. Supreme Court, asking the highest court to review the rejection by a federal appeals court.

Q&A: AAFP's alternative payment model focuses on primary care

American Academy of Family Physicians (AAFP) President John Meigs Jr., MD, took a deeper dive with HealthExec into the new model, titled the Advanced Primary Care Alternative Payment Model (APC-APM), including what current APMs inspired its components and how it could help smaller primary care practices qualify for the 5 percent APM bonus.  

New Jersey’s Hackensack Meridian, JFK Health agree to merge

Hackensack Merdian Health would grow to a 15-hospital system in northern and central New Jersey under its new merger agreement with JFK Health.

1,600 Brigham and Women’s employees offered voluntary buyouts

Brigham and Women’s Hospital in Boston has presented 1,600 employees—nearly 9 percent of its workforce—with the option of a voluntary buyout as the hospital looks to cut costs.

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