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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

Anthem files for expedited appeal of decision blocking Cigna merger

Anthem is asking the D.C. Circuit Court of Appeals to rush the appeals process as it tries to reverse a lower court’s ruling blocking its $54 million of acquisition of Cigna.

Aetna, Humana officially kill merger

Health insurers Aetna and Humana have mutually ended their $37 billion merger agreement two weeks after a federal judge blocked the deal on antitrust grounds. 

$54 billion Anthem-Cigna merger blocked by federal judge

The $54 billion acquisition of Cigna by Anthem has met the same fate as the $37 billion merger of Aetna and Humana: blocked by a federal judge on antitrust grounds. 

Lowered reimbursements are C-suite’s top fear with ACA repeal

In a survey of healthcare executives, many said they want several provisions of the Affordable Care Act (ACA) to stay in place if the law is repealed, while expressing concerns over how its elimination could affect their reimbursements from Medicare and Medicaid.

TeamHealth to pay $60 million to settle overbilling allegations

Physician staffing company TeamHealth has agreed to pay a $60 million penalty to settle allegations that one of its subsidiaries told hospitalists to “up-code” and overbill Medicare, Medicaid and other federal programs.

Healthcare consolidation isn’t driven by ACO participation

While the consolidation trend across healthcare accelerated after the Affordable Care Act (ACA) was passed, there's little evidence connecting consolidation to providers wanting to succeed under accountable care organization (ACO) programs created after the ACA, according to a study published in the February issue of Health Affairs.

Coding intensity could lead to $200 billion spending jump in Medicare Advantage

CMS will likely overpay Medicare Advantage plans by hundreds of billions of dollars over the next 10 years if the agency doesn’t account for coding intensity in its risk scores.

Group purchasing cuts costs, optimizes supply chain

A report from the Healthcare Supply Chain Association (HSCA) said the group purchasing organizations (GPOs) it represents help cut supply chain costs by an average of 15 percent and reduce drug spending by 25 percent.

3 ways to proactively identify underpayments before CMS audits

A Recovery Audit Contractor (RAC) review from CMS isn’t cause for celebration for most healthcare organizations, but it can be beneficial if those facilities take proactive steps to identify underpayments.

CMS proposes 0.25% increase in Medicare Advantage payments for 2018

CMS is offering a more modest 0.25 percent increase in payment rates for Medicare Advantage (MA) insurers, one year after a 0.85 percent hike, in its proposed MA update for 2018. 

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