Healthcare Finance News

Reimbursement Humana joins Aetna in covering in-patient hospital admissions for COVID-19 related treatment. More… Revenue Cycle Management Understanding contract loopholes, and being self-advocates during negotiations, can help community hospitals increase their collections. More… Strategic Planning In Orlando, health IT professionals will get an update on what FHIR currently can and […]

Reimbursement

Cigna, Humana, other insurers waive costs for COVID-19 treatment

Humana joins Aetna in covering in-patient hospital admissions for COVID-19 related treatment.

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Revenue Cycle Management

Managed care, revenue cycle performance strategies are critical to increasing payer yield

Understanding contract loopholes, and being self-advocates during negotiations, can help community hospitals increase their collections.

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Strategic Planning

Forecasting the future of HL7 FHIR at HIMSS20

In Orlando, health IT professionals will get an update on what FHIR currently can and can’t do – and what to expect from it going forward.

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Capital Finance

Coronavirus is impacting the financial health of nonprofit hospitals, but CFOs have some options

Revenue is tanking, while expenses are going up, as organizations prepare for big surges in coronavirus cases.

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Supply Chain

Trump accuses hospitals of hoarding ventilators and other supplies during coronavirus pandemic

With COVID-19 spreading, Trump has suggested that the increase in demand for supplies may not be due solely to the virus.

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Budgeting

A dynamic healthcare budget process may trump traditional budgeting in terms of accuracy, flexibility

With a labor-intensive budgeting process that provided little business value, OSF Healthcare decided it was time to be more flexible.

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Quality and Safety

Survey confirms physicians lack tests and equipment to fight COVID-19

Half of U.S. physicians say they have treated a patient with COVID-19 symptoms, while three-quarters report not being able to test easily.

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Billing and Collections

For payers, patients and employees, coronavirus spending could exceed $20,000 for the most serious cases

Since all of the estimates are based on pneumonia, it’s likely that costs will be even higher during the coronavirus outbreak.

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Claims Processing

Humana is expediting claims processing and prior authorization during COVID-19 pandemic

Prior authorization requirements have hindered freeing up hospital beds due to delays in getting inpatients to post-acute care.

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Workforce

Some COVID-19 patients still have coronavirus after symptoms disappear, possibly endangering health workers

The message is clear: Nurses and physicians should treat asymptomatic patients as carefully as symptomatic patients.

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Operations

Retrospective denials, prior authorization may be straining hospital and patient finances

While not all insurers may be aware of it, prior authorizations can have detrimental downstream financial effects for hospitals and health systems.

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Medical Devices

Apple is developing custom health information tracking chips

The custom sensor would measure information from the body beyond heart rate, report says.

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Compliance & Legal

DOJ accuses Anthem of fraud in risk adjustment payments for its Medicare Advantage plans

Anthem claims the DOJ has violated the law in holding Medicare Advantage plans to payment standards that are not applied to regular Medicare.

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Policy and Legislation

AHA wants federal stimulus funds to go directly to hospitals

HHS and CMS should immediately distribute funds to every hospital at the rate of $25,000 per bed, or $30,000 in hot spots, AHA says.

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Community Benefit

Advocate Aurora Health contributed $2.1 billion to community charitable care and services in 2018

The nonprofit health system has sponsored numerous programs and services that help address social determinants of health.

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Accountable Care

NAACOS urges CMMI to release more information on new payment model

Lack of information on key financing aspects is preventing ACOs from signing on, says NAACOS president.

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Acute Care

Critical care improvements may differ depending on a hospital's patient population

There was a 2% drop in ICU deaths at non-minority hospitals, but the same improvement rate was not seen at minority-serving hospitals.

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Ambulatory Care

Medical schools, teaching hospitals account for 3% of US GDP, report shows

The institutions that were studied added more than $562 billion in value to the nation’s economy in 2017, including direct and indirect economic impact.

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Analytics

How analytics, SDOH insights are helping reduce ED use

At HIMSS20, one physician association will show how data-driven care management, with prompt patient outreach, helped decrease ED use by 8%.

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Business Intelligence

While the price of healthcare is growing, utilization is dropping and price variations persist, report says

Report analyzed more than 1.8 billion commercial healthcare claims and data visualization to benchmark prices and use across 112 metropolitan areas from 2012 to 2016.

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ICD-10 & Coding

Physician practices examine risk adjustment coding in wake of federal lawsuits

Doctors need to carefully and properly use the HCC codes, which indicate the expected costs for a patient.

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Meaningful Use

CMS overhauls meaningful use EHR program, renames it 'Promoting Interoperability'

Administrator Seema Verma said changes to the program eliminate 25 measures and saves hospitals over 2 million hours of work and $75 million.

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Medicare & Medicaid

Hospitals can bill for treatment outside their four walls in new regulatory flexibility

CMS is also allowing ERs to use drive-through testing and telehealth, and for tests to be done at home for stay-at-home residents.

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Patient Engagement

Better data sharing between payers, providers can move the needle on social determinants of health

More robust SDOH data is not only a care quality consideration, but a business consideration as payers, providers seek a whole-person view.

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Pharmacy

AHIP supports federal regulation of PBMs in Supreme Court case

Should states win their case to regulate how PBMs contract with pharmacies, plan costs will rise, AHIP says.

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Population Health

United Health Foundation donates $5 million to support the homeless, food insecure, during COVID-19 crisis

UnitedHealth Group previously announced $50 million to fight COVID-19 by supporting healthcare workers, seniors and hard-hit communities.

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Risk Management

Cybersecurity needs to be put in business terms

IT security is a legacy word, says Brian Selfridge: “This isn’t cybersecurity, this is risk.”

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Telehealth

Virtual health: From Camp Fire to coronavirus

Paradise Medical Group is running a virtual practice as the federal government has announced expanded access to telehealth services.

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