ObamaCare fix hinges on Medicaid clash in Senate

The most divisive issue for Senate Republicans when it comes to repealing and replacing ­ObamaCare is what to do with Medicaid.

The Affordable Care Act gave states the option of accepting federal funds to expand Medicaid, the healthcare program for the poor and disabled. Millions of people gained health insurance after 31 states — including many with Republican governors — decided to accept the deal.

Repealing ­­ObamaCare would end the Medicaid expansion, cutting federal funds to all of those states.

Some Republicans want to save the expansion at least through a transition period during which states would continue to get additional federal funds.

Others, including lawmakers from states that didn’t take the expansion, say all of ­ObamaCare has to go, with no long, costly transition period for Medicaid.

The fact that some states took the expansion and others didn’t provides a dividing line that will pit Republicans against one another.

Sen. John Thune (R-S.D.) calls it the single thorniest issue of the entire debate.

“You don’t want to punish or penalize states that didn’t expand , but the states that did expand are going to say, ‘We don’t want to get punished for expanding, either.’ To me, that’s probably the thorniest and most difficult issue to […]

By |February 26th, 2017|Health Reform, Medicare/Medicaid|Comments Off on ObamaCare fix hinges on Medicaid clash in Senate

Despite Provision Delay, New Bundles on Schedule

Some provisions of Medicare’s first mandatory bundled payment model were recently delayed, but federal officials say new mandatory models still will launch in July.

The Centers for Medicare & Medicaid Services (CMS) recently issued an announcement that application of some early provisions of the Comprehensive Care for Joint Replacement (CJR) model will be delayed from Feb. 18 to March 21.

But the delay did not impact the CJR expansion model—called the Surgical Hip and Femur Fracture Treatment (SHFFT) model—or the Acute Myocardial Infarction (AMI) and the Coronary Artery Bypass Graft (CABG) models, all of which begin July 1, CMS officials said in a Feb. 22 conference call, according to industry participants.

The delayed CJR provisions include a requirement for participating hospitals to have physicians deliver a written notice to beneficiaries describing their participation in the CJR program, advisers said.

“It’s seemingly small, technical specs that were impacted by the memorandum, and even those delays were not significant,” Brian Fuller, vice president for value-based care for naviHealth, said in an interview.

According to CMS, 860 hospitals are participating in CJR, which launched in April 2016 and places hospitals at risk for all Medicare spending associated with hip and knee replacements and any charges within 90 days […]

By |February 24th, 2017|Health Reform|Comments Off on Despite Provision Delay, New Bundles on Schedule

5 RCM metrics hospitals should monitor to improve cash flow

Hospitals and health systems continuously monitor revenue cycle management metrics, as they play a key role in helping organizations receive maximum reimbursement and an accurate assessment of their billing department.

However, to maintain profitability, organizations must select and track metrics that push them to surpass expectations.

“Understand where you are today and have goals of where you want to go. Looking at how you’re summarizing the information, looking at how you’re tracking and trending the information, looking at how you’re budgeting and trending for that information is very important,” says Nicole Davis, senior vice president of channel managementat IKS Health, which manages RCM functions for health systems and large physician groups.

“Some metrics you’ll want to look at on a daily basis, while others you’ll look at from an operational standpoint and others from a quarterly or monthly perspective to get a better understanding of holistically are we moving in the direction we want to go,” she added.

But with so many metrics to evaluate, which are most important to track?

Ms. Davis recently spoke with Becker’s Hospital Review about which metrics to focus on to improve cash flow. Below, she provides five metrics for hospitals and health systems to continuously monitor.

1. First pass […]

By |February 24th, 2017|Collections, Industry News|Comments Off on 5 RCM metrics hospitals should monitor to improve cash flow


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