Reimbursement

Among the least popular decisions handed down by the Centers for Medicare & Medicaid Services in recent years, it’s hard to top the rule requiring hospitals to rein in readmission rates or suffer the financial consequences. As most CFOs are painfully aware, those consequences include substantial reductions in reimbursements.

Hospitals in states that don’t expand their Medicaid program as outlined under the Affordable Care Act are facing significant revenue reductions due to regulations that will reduce some Medicare and Medicaid payments in 2014, measures that were written into the law to help pay for the expansion of the insurance program for the poor.

By now, it is no surprise which states have said they won’t expand Medicaid as outlined under the Affordable Care Act. And while there are still a handful of states on the fence, it’s a given that states like Texas, Louisiana, Mississippi and Georgia, among others, were not going to budge.

President Barack Obama's fiscal 2014 budget includes a variety of what he says are "manageable" changes for Medicare's 54 million beneficiaries as well as for the hospitals, nursing homes and other healthcare providers that serve them.

With no comprehensive program designed to provide long-term care insurance, a panel of experts who convened in March agreed that comprehensive reform has about a five-year window for implementation in order to sufficiently meet the needs of baby boomers.

In January, the Affordable Care Act (ACA)’s individual mandate will enter the next phase of its roll out. Millions of uninsured Americans will face penalties if they do not enroll in a health plan. Uninsured problem solved, right?

Although physicians have always valued prompt, accurate and complete claims payment, the need for such payment has become more important as physician practices try to balance increasing costs with shrinking reimbursement.

The Workgroup for Electronic Data Interchange announced Thursday that it had submitted its ICD-10 industry readiness survey to the Centers for Medicare & Medicaid Services. Its findings continue to show insufficient readiness for the October 2014 transition deadline.

In most states, the difference between premium rates for young and old members is already largely within the 3:1 ratio set by the Affordable Care Act, according to a new study by the consumer website Health Pocket.

With the Affordable Care Act entering the home stretch of implementation, U.S. Senators are still trying to understand the costs and benefits of market reforms, while diagnosing problems in the greater healthcare system.