Revenue Cycle News Update – July 12, 2019
This regular feature showcases the most vital recent news stories in healthcare IT and revenue cycle management.
Here are the top stories since our last news roundup, as well as what you’ll need to know in the next few weeks.
Medicare / Medicaid News
The shift to value-based care has driven public and private payers to redesign reimbursement models that stress accountability for care quality and healthcare costs. According to the article, if the cost of the episode is less than the bundled payment set price, then providers can keep the difference. However, if the cost is more, participating parties lose the difference.
According to a new analysis from the Center for American Progress (CAP), hospitals had the highest level of profitability in about a decade and more than payers, pharmacies, and pharmacy benefit managers. CAP estimated that hospitals received about 134 percent of Medicare rates across their main payers, like private payers and Medicaid.
When CMS feels it cannot get enough participation, or it has an adverse selection for voluntary models, the agency said it will use mandatory payment models instead. This comes after CMS Administrator Seema Verma claimed that some upcoming models will be mandatory.
Private Payer News
“We believe that asking our patients to pay a portion upfront for nonemergency care is a reasonable approach,” Matt Gove, Piedmont’s chief consumer officer, told Georgia Health News. “And based on our initial feedback from our patients, [they believe] it is reasonable.”
The Trump Administration touted a new executive order on hospital price transparency as a “historic action … fundamentally changing the nature of the healthcare marketplace.”
“This month and over the last few we have seen some brighter points when it comes to inpatient and ED volumes.” said Erik Swanson, a vice president of Kaufman Hall.
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