Billing and Collections
The number of beneficiaries absolutely losing coverage is expected to be 8M, with some not reapplying even if they qualify for Medicaid.
The ACA is seen as an alternative for Medicaid coverage as states begin the redetermination process starting April 1.
When the next phase of the final rule's rollout occurs in January, payers will need to be ready for a new world of price transparency.
The authors framed coding practices as one element of an ongoing "tug-of-war" between payers and providers.
A three-judge panel in Florida ruled TeamHealth was owed $10.8 million due to underpayments from UHC from 2017 to 2020.
However, providers who previously were able to balance-bill patients may now be using the IDR process to collect above-market reimbursement.
Physicians see the need to reduce the gaming of risk adjustment and to create accountability focused on outcomes, not processes.
Across all practices, the median revenue amount from value-based contracts was $30,922 per provider.
The majority of bad debt now is associated with patients with insurance, contributing to the net revenue challenge for hospitals.
The agency claims it collected $272 million of those overpaid claims, but supporting documentation indicates just $120 million.