Businessman holding financial graphics
April 16, 2015
Package payments may be small at the moment, but new programs are expanding across the board. Here's what to know before jumping in.
Get the Medical Practice Insider weekly email newsletter. Subscribe today!

Reimbursements

  • News
  • Best Practices
  • Resources
  • Blogs
  • Press Releases
Narrow by Topic:
Drugmakers hike prices regardless of rebates, says PCMA June 19, 2017 | Jeff Lagasse - Healthcare Finance Associate Editor
Some high-priced drugs like Sovaldi, a hepatitis C drug which initially cost $84,000, involved no rebates until other competitors came to market.
Beginning this year, clinicians participating in MIPS have to report on six quality measures to be eligible for a bonus payment.
Less than half of physicians are satisfied with their compensation June 19, 2017 | Susan Morse - Associate Editor, Healthcare Finance
Reason is declining reimbursement rates coupled with an increase in the administrative burden, particularly due to EHRs.
Private insurance spending increased in non-expansion states, Health Affairs finds June 19, 2017 | Jeff Lagasse - Healthcare Finance Associate Editor
Most of that reflects the significant increase in private insurance enrollment during that period, which was greater in those states.
Healthcare groups urge CMS to count Medicare Advantage contracts as APMs in MACRA June 12, 2017 | Jeff Lagasse - Healthcare Finance Associate Editor
That step, they say, would keep Medicare Advantage relevant, to the benefit of patients in the Medicare program.
AHIP: No matter the political landscape, value-based care will continue June 12, 2017 | Susan Morse - Associate Editor, Healthcare Finance
Reimbursement has not caught up to technology innovations, expert says.
AHIP: The role of payer and pharma in affordability of drugs June 12, 2017 | Susan Morse - Associate Editor, Healthcare Finance
Value-based agreements are increasing between health insurers and pharmaceutical manufacturers.
CMS issues call for clinicians to propose, submit new MIPS measures June 12, 2017 | Beth Jones Sanborn - Managing Editor of Healthcare Finance News
Deadline to submit proposed measures for consideration is June 30, 2017.
CMS overpaid nearly $730 million in meaningful use incentives, OIG says June 12, 2017 | Jessica Davis - Associate Editor, Healthcare IT News
Failure to conduct minimal documentation reviews left the incentive program open to abuse of federal funds, agency says.
Most healthcare providers don't know cost of a common ER visit, study says June 06, 2017 | Jeff Lagasse - Healthcare Finance Associate Editor
Improving the percentage has the potential to lower costs for patients and the overall healthcare system.
Insurers could be offering employer plans that contain no contraception coverage, under proposed rule June 06, 2017 | Susan Morse - Associate Editor, Healthcare Finance
Trump Administration rule does not change standard requiring such coverage when no objection exists, but about any employer could seek an exemption.
Healthcare groups urge CMS to count Medicare Advantage contracts as APMs in MACRA June 06, 2017 | Jeff Lagasse - Healthcare Finance Associate Editor
That step, they say, would keep Medicare Advantage relevant, to the benefit of patients in the Medicare program.
Hepatitis C drug again tops Part D spend list at $7 billion May 30, 2017 | Susan Morse - Associate Editor, Healthcare Finance
CMS posts $137 billion in Part D prescription drug data, an increase from $121 billion spent the year before.
Numbers of uninsured would increase by 23M under AHCA, CBO says May 25, 2017 | Susan Morse - Associate Editor, Healthcare Finance
In 2026, an estimated 51M people under age 65 would be uninsured, compared to 28M who would lack insurance under current law.
Healthcare price transparency tools seldom used, study finds; more reminders, marketing needed May 25, 2017 | Jeff Lagasse - Healthcare Finance Associate Editor
Younger patients, those with higher deductibles and those living in a higher-income community were the most likely to use the tool.
Economists propose paying physicians salary over fee-for-service method to avoid conflicts of interest May 19, 2017 | Jeff Lagasse - Healthcare Finance Associate Editor
Fee-for-service compensation arrangements, they propose, create incentives for physicians to order more services than are best for patients.
Economists propose paying physicians salary over fee-for-service method to avoid conflicts of interest May 11, 2017 | Jeff Lagasse - Healthcare Finance Associate Editor
Fee-for-service compensation arrangements, they propose, create incentives for physicians to order more services than are best for patients.
More states reimburse for telemedicine under Medicaid than you think May 02, 2017 | Bill Siwicki - Managing Editor of Healthcare IT News
A new report found an uptick in state's practices for live video consults, store-and-forward and remote monitoring services.
How does blockchain actually work for healthcare? April 17, 2017 | Mike Miliard - Contributing Editor
To say the technology is advanced is an understatement, but hospitals should understand the reasons that it's getting so much attention.
CMS releases mixed payment rules for inpatient, long-term care April 17, 2017 | Susan Morse - Associate Editor, Healthcare Finance
CMS is proposing to reduce clinical quality measure reporting requirements for hospitals that have implemented electronic health records.

Pages

How to prepare for bundled payments April 16, 2015 | Sherree Geyer - Contributing Writer
Businessman holding financial graphics
Package payments may be small at the moment, but new programs are expanding across the board. Here's what to know before jumping in.
SGR fix would narrow Medicare physician payment gap March 30, 2015 | Sherree Geyer - Contributing Writer
Dollar sign
Reimbursement rates have essentially been frozen in the absence of an accurate payment formula; meanwhile, doctors are taking on more complex cases than ever.
How it can pay to outsource medical billing March 09, 2015 | Divan Dave - CEO of OmniMD
raining money
Even an excellent in-house biller can't do it all. Consider these areas where it may make sense hire an outside firm.
Electronic data exchange streamlines adjudication February 23, 2015 | Lindy Benton - CEO of MEA/NEA
Coding
Claims processing and other requests for information by outside parties should be expedited and secured through electronic filing.
Why providers should charge like hotels February 09, 2015 | Bill Marvin - CEO of InstaMed
insurance claim papers
Some argue that consumers should be able to view a total price for healthcare services in advance. But that's not a completely effective way to communicate payment responsibility.
5 ways to improve revenue management November 06, 2014 | Johanna Epstein - Vice President of Strategy and Executive Leadership Services at Culbert Healthcare Solutions
Practice revenue cycle management
Medical groups need to examine their revenue cycle systems to determine if they are capable of supporting business and operational goals. These quick recommendations will help you get started.
10 ways to maximize cash flow October 29, 2014 | Frank Irving - Editor
money in pocket
Recommendations for getting the most from your collection efforts and strategies for avoiding costly mistakes.
3 steps for getting your patients to pay up August 04, 2014 | Jeff Wood - Vice President of Product Management at Navicure
dollar bills
More education regarding financial responsibility and options for making payments will go a long way toward reducing expensive claims management work. Here's a proactive strategy for establishing clear and ongoing communications.
Virtual payments: not just a phase July 21, 2014 | Bill Marvin - CEO of InstaMed
dollar bill
They're less expensive for payers than mailing paper checks, so providers should expect rising use of virtual cards. Here's how to successfully handle this emerging form of payment.
Making the case for electronic claims attachments June 13, 2014 | Lindy Benton - CEO of MEA/NEA
computers with binary code
Providers who automate the claims process by going electronic will be paid sooner than those still reliant solely on hard-copy record transmission. And AHIP has the data to prove it.
How to challenge insurance recoupments April 16, 2014 | Madelyn Kearns - Associate Editor
Preparing to challenge insurance recoupments
Recent court rulings support a remedy against payers offsetting alleged provider overpayments against new and unrelated claims.
Survival guide to PQRS March 31, 2014 | Madelyn Kearns - Associate Editor
Survival guide to PQRS
These four best practices will help you qualify for incentives, avoid future penalties, and make reporting quality measures part of your care standard to the benefit of your practice and the patients it serves.
4 tips for more effective collections March 26, 2014 | Kelsey Brimmer - Associate Editor
4 tips for more effective collections
These tactics will help ease the awkward process of making sure patients pay up for healthcare services rendered.
Which financials to track and how often February 26, 2014 | Kavita Sahai - VP Medical BackOps
Financial reports: What to track and how often
There's no way to manage what you do not measure. That's why you need to stay on top of specific accounting measures on a regular schedule.
7 questions to ask before payment auditors come knocking November 26, 2013 | Madelyn Kearns - Associate Editor
7 questions to ask before payment auditors come knocking
Because even honest doctors can find themselves facing an overpayment audit, adhering to these tips will help you survive unscathed.
3 techniques for maximizing accounts receivable November 20, 2013 | Xavier E. Martinez
3 techniques for maximizing accounts receivable
A few straightforward steps can help your practice collect more payments in less time.
4 ways to improve payer-provider relations October 15, 2013 | Salvador Lopez - Content Writer, CareCloud
4 ways to improve payer-provider relations
Forming fruitful relationships with the companies that reimburse your claims can be the difference between getting paid or not.
Making your revenue cycle efficient October 02, 2013 | Brian Fugere - Chief Operating Officer, RemitDATA
Making your revenue cycle efficient
Managing cash flow is a critical function for the practice administrator as well as for the entire revenue cycle staff. Leveraging solutions to monitor and drive performance improvement, along with process mapping, is a quick and easy way to get your cash earlier.
Engaging the patient: Crucial to improved outcomes September 09, 2013 | Janet Duni, RN, BSN, CCM, MPA - Director of Care Coordination at Vanguard Medical Group
Engaging the patient: Crucial to improved outcomes
Vanguard Medical Group, a 20-provider, three-location primary care practice in Northern New Jersey, leverages information technology tools to identify and track high-risk patients and engage them in their care. Using a team-based care model, the goal is for providers to develop a disease-related "action plan" with each high-risk individual.
Getting the most out of your MU dollars September 03, 2013 | Marla Roberts, DrPH, RN - Solution Manager at CTG Health Solutions
Getting the most out of your MU dollars
Even practices that invested early and were ready -- or close to ready -- to achieving the purpose of meaningful use should take another look. Well-placed investments will contribute to sustaining change and setting a solid foundation for escalating MU requirements.

Pages

5 factors casting doubt on the SGR fix March 24, 2015 | Frank Irving - Editor
Frank Irving
Anything can happen in politics -- especially when it involves funding deadlines. But there are reasons to believe the sentiment trending against an imminent, permanent solution.
What will happen with the SGR fix? March 12, 2015 | Frank Irving - Editor
Frank Irving
Cast your vote on the likelihood of another patch or a permanent solution being passed by Congress by March 31.
Top talking points: Suite payment models, vaccination and virtual reality February 13, 2015 | Madelyn Kearns - Associate Editor
Welcome back to "Doc Talk." For this installment, we delve into the concept of charging patients like hotels, the best way to deal with anti-vaxers and the prospect of virtual reality in healthcare.
AMA responds to HHS goal-setting for Medicare reimbursements January 27, 2015 | Robert Wah, MD - President of the American Medical Association
Robert Wah, MD
Government's efforts align with the physician association's work toward care delivery reform.
Look who's talking about the frustrations of meaningful use January 09, 2015 | Madelyn Kearns - Associate Editor
Madelyn Kearns
Welcome back to "Doc Talk." This week, we focus exclusively on what you and your fellow providers had to say about meaningful use and why you're not attesting for Stage 2.
It's time to update telehealth payment policy December 17, 2014 | Krista Drobac - Executive Director of the Alliance for Connected Care
Krista Drobac
Obsolete qualifications for Medicare beneficiaries counteract the care-provision capabilities of today's technology.
Why you need to get a handle on denials November 13, 2014 | Carl Natale - ICD10Watch
Carl Natale
Start now with a denial management strategy so that you're not scrambling to cope with reimbursement delays after the ICD-10 deadline.
ICD-10 hasn't gone away, nor has the drive to improve the overall claims management process. At the same time, data analytics are scaling down to small practices.
The cowboys of healthcare costs August 13, 2014 | Jeff Rowe - Contributing Writer
cowboy
Culprits are driving America's healthcare costs upward by as much as a half-trillion dollars. Are you one of them?
Providers face Medicaid dilemma July 24, 2014 | David Williams - Health Business Blog
David Williams
In many states, doctors who take care of a high proportion of Medicaid patients will find themselves in financial distress. That's not fair to them or their patients.
The basic healthcare transaction July 17, 2014 | Rob Lamberts, MD
Rob Lamberts, MD
The provider is rewarded for finding the best-paying procedure code to match the most severe problem codes. Where is the patient in all this?
This weeks top commentary: Doc rankings, healthcare spending and ACOs June 13, 2014 | Madelyn Kearns - Associate Editor
doc talk quote
Welcome to this week's "Doc Talk," wherein we discuss doctor reputations and rankings, healthcare spending after ACA, and patient agency.
The Affordable Care Act is here -- and you have leverage January 17, 2014 | Tom McGuinness, CPA, CVA - Founding Partner, Reimer, McGuinness & Associates, P.C., Boyle Henderson, Jr., CPA - Director of the Healthcare Practice at Daenen Henderson & Company
Tom McGuinness
Insurance plans are pleading for your participation in their plans.
Physicians remain anxious over lack of SGR progress December 04, 2013 | Stephanie Bouchard - Managing Editor, Healthcare Finance News
Stephanie Bouchard
No one has been successful in getting repeal legislation passed, largely because a viable plan for paying for it has yet to be developed.
Bipartisan SGR bill could fix more than just the Sustainable Growth Rate December 04, 2013 | Dan Haley - Vice President, Government and Regulatory Affairs, athenahealth
Dan Haley
With the right modifications, the SGR bill could make a meaningful difference in Medicare reimbursement, ensuring that all doctors are treated fairly, paid for their services, and able to seamlessly share valuable patient information.
The absolute case for relative value units December 02, 2013 | David Williams - Health Business Blog
David Williams
Maybe we should adapt RVUs to the new environment of alternative payment models rather than throwing them out the window.
The rollout of the Affordable Care Act October 23, 2013 | Tom McGuinness, CPA, CVA - Founding Partner, Reimer, McGuinness & Associates, P.C.
tom mcguinness
As a consultant to physicians, my advice at present is to collect your fees up front. This is based upon practice survival skills learned from years in the trenches.
Washington, we have a problem September 23, 2013 | Rob Lamberts, MD
Rob Lamberts, MD
There is pressure now to respond to each "problem" with a procedure, or at least something to eliminate it as a problem.
Tax planning for 2013 August 19, 2013 | Tom McGuinness, CPA, CVA - Founding Partner, Reimer, McGuinness & Associates, P.C., Marc H. Lion, CPA, CFP - Founding Member, Lion & Co., CPAs LLP
Tom McGuinness
If you haven't already run a 2013 tax projection based upon 2012 income, it's time to do so now.
Should we care if doctors drop Medicare? August 06, 2013 | David Williams - Health Business Blog
David Williams
Does it really make sense to use an insurance mechanism for routine, relatively low-cost expenditures such as primary care?

Pages

CMS names Pulse Systems a qualified PQRS Registry for 2014 May 29, 2014 | Medical Practice Insider Staff
Eligible Providers using the Pulse Complete EHR or PulsePro Practice Management solutions can increase their Medicare reimbursement while improving patient care.
Proven Florida Track Record and Personalized Service Seals the Deal.
Navicure Launches Navicure Receivables Manager November 13, 2012 | Industry Release
Navicure, a leading Internet-based medical claims clearinghouse for physician practices, today announced the release of its new Navicure Receivables Manager, a central repository for insurance denials, appeals and payments, that streamlines denial and appeal management by automating the entire process. The solution, which is an evolution of Navicure’s ERA Filing Cabinet, helps physician practices decrease days in A/R, accelerate cash flow and improve staff productivity.
ADP AdvancedMD, a leader in all-in-one, cloud-based electronic health record (EHR), practice management (PM), and medical scheduling software as well as medical billing services, today announced a webinar titled “Preparing for the 2013 Medicare Cut and Improving Your Practice’s Long Term Financial Performance,” with Frank Irving, editor of PhysBizTech and Anne M. Dunne, Director of Healthcare Management Consulting, Grassi & Co, an ADP AdvancedMD partner. The complimentary webinar takes place on Thursday, October 18 from 12-12:30 p.m. Eastern / 9-9:30 a.m. Pacific time. Participants will learn about the Centers for Medicare and Medicaid Services’ (CMS) rule imposing a seven percent reduction in specialists’ pay for 2013, on top of proposed “sustainable growth” reductions of 27 percent.
WebPT, developer of Web-based software that makes rehab clinics more efficient, has partnered with CollaborateMD, a Web-based medical billing software provider. The integration with CollaborateMD is part of WebPT’s move beyond EHR to become a comprehensive solution for rehab clinics. WebPT’s EHR system gives therapists an easy, secure, Web-based system for their documentation needs, along with real-time practice management services to improve clinic workflow.
WebPT, developer of Web-based software that makes rehab clinics more efficient, has partnered with CollaborateMD, a Web-based medical billing software provider. The integration with CollaborateMD is part of WebPT’s move beyond EHR to become a comprehensive solution for rehab clinics. WebPT’s EHR system gives therapists an easy, secure, Web-based system for their documentation needs, along with real-time practice management services to improve clinic workflow.
26% of primary care physicians report poor financial health in the most recent QuantiaMD Physician Wellbeing Index. This financial instability, coupled with mounting professional challenges, and a dearth of incentives, are major factors driving new physicians away from primary care and into more lucrative subspecialties. This trend is especially worrying at a time when key aspects of the Patient Protection and Affordable Care Act (ACA) rely heavily on primary care physicians for success.
Colorado Beacon Community partner Rocky Mountain Health Plans (RMHP) will be part of a project to re-envision the role of behavioral health in primary care. If it succeeds, the effort could transform the nation's approach to behavioral health by better integrating the delivery of behavioral and physical health care.
In order to receive reimbursement for patient claims, U.S. healthcare providers must begin using a revised global system for classifying medical diagnoses and inpatient procedures by Oct. 1, 2014.  While more than two years sounds like plenty of time to implement a new system, the number of possible diagnostic codes will increase dramatically from 14,000 to 68,000, while the number of inpatient codes will increase from 4,000 to 87,000. Crowe Horwath LLP, one of the largest public accounting and consulting firms in the U.S., suggests steps that providers can implement ahead of the conversion deadline for a smoother transition.
WorkSmart MD, Inc. has announced its launch of medicalbillinghelper.com an educational website that helps physicians and community health centers (FQHC) improve their profitability and maximize medical billing revenue.
A new ICD-10 financial impact analysis tool and comprehensive ICD-10 financial impact consulting services are the latest additions to the full suite of ICD-10 transition planning solutions offered by 3M Health Information Systems. The new software and services are designed to help healthcare organizations analyze the reimbursement impact of ICD-10 in order to identify and target critical revenue and operational impact areas for improvement.
 A recent global analysis of product evaluations for Health Technology Assessments  – which are often influential in decision making for approving and/or providing reimbursement for pharmaceuticals and other medical technology – found that the use of patient-reported outcomes (PROs) increased between 2005 and 2011. The study also showed substantial variation across both nations and treatment areas in applying HTAs to such decisions.
WebPT, developer of cloud-based software that makes clinics more efficient, now offers a revenue cycle management service in addition to its industry-leading EHR system for physical therapists. Leveraging a team of deeply experienced billing specialists, WebPT is now offering a complete, turnkey solution to make billing and collections more efficient.
 When physicians see patients outside of their office (in the hospital, at a surgery center, in nursing homes), they typically scribble their charges on whatever paper is nearby and deliver it to the billing staff once they return to the office. Physicians are looking for a more accurate and reliable way to capture these charges without slowing them down.
Netsmart, the leading provider of clinical solutions for health and human services organizations nationwide, today launched Netsmart Plexus Revenue Cycle Management, a comprehensive billing and revenue management service that provides health and human services providers with an efficient, cost-effective solution to manage their financial health and increase the efficiency of their billing and collections processes.