Resources by BHM Healthcare Solutions

Bundled Payments | Rewarding Quality and Value

April 15, 2014

Summary: The healthcare industry is transforming from fee-for-service to value-based payment systems. One of the fairly new forms of reimbursement to hit the streets is bundled payments.

Overview of Bundled Payments

The Medicare reimbursement system is in the process of transforming healthcare as we know it from a traditional fee-for-service model to a system that rewards based on quality, care coordination, accountability, and healthcare cost savings.

Healthcare Buzzwords: What is Big Data?

April 14, 2014

The term “Big Data” has only recently entered the healthcare and medicine verbiage. It used to be largely reserved for the larger-than-life scientific research that spanned the entirety of the universe. It’s no surprise that the concept of Big Data has translated nicely to the universe inside of us.

ICD-10 Delay: Does ICD-10 Lack Clinical Value?

April 11, 2014

ICD-10 was delayed once again as part of a bill that was meant to fix the physician reimbursement issues with Medicare. The ICD-1o delay was merely a footnote in a jam-packed bill that was going to make many doctors very happy; incidentally, pushing out the date for ICD-10 implementation also pleases many physicians. Some have gone so far as to say, on record, that ICD-10 lacks clinical value.

Understanding RVUs and Medicare Reimbursement

April 10, 2014

Summary: Do you understand Relative Value Units (RVUs) as they relate to Medicare reimbursement? Is your physician compensation model based upon RVUs or a derivative thereof?

What is an RVU?

RVU stands for Relative Value Unit and is currently used by Medicare to determine the amount of reimbursement to providers. RVUs are basically a way of standardizing and comparing service volumes across all continuums.

Medicare Advantage Cuts Not Only Delayed But Reversed

April 9, 2014

Summary: CMS has reversed its original proposal to cutback Medicare Advantage plan reimbursement for 2015. The reversal is a result of aggressive lobbying from organizations such as the American Medical Association.

What is Medicare Advantage?

According to www.medicare.gov, a Medicare Advantage plan is “a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.”

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Dual-Eligibility: An overworked & overlooked population?

April 7, 2014

9 million Americans are covered by both Medicare and Medicaid and are part of a unique community of healthcare consumers known as the dual eligible. Dual eligible beneficiaries often have complex health conditions and may be low income, meaning that their access to healthcare would be greatly limited if not for their dual eligibility for coverage.

Providers: Shifting Landscape and Mindset

April 4, 2014

As a result of the Affordable Care Act as well as other healthcare legislation, a shift is occurring in healthcare from the provider’s perspective. In order just to survive (not even prosper), physicians are changing the way they conduct business and choosing which patients will be seen.

Shifting Landscape and Mindset – Changes in Medicare
•Medicare reimbursement is certainly on the forefront. Reductions, even if 1% or less, can drastically affect a provider’s bottom line. Consequently, some providers are limiting the number of Medicare patients seen by their practice. Some providers have completely eliminated access to these patients.

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Hospital Acquired Infections: The Diagnosis That Could Have You Paying an Extra $40,000 Per Patient

April 3, 2014

Hospital Acquired Infections (HAIs) occur when a patient is exposed to a bacterium, virus or fungi during their hospital stay that leads to an additional condition. These additional conditions can cost hospitals thousands of dollars in lost revenue.

Observation Units – Bridging the Gap Between Inpatient and Outpatient

April 2, 2014

What is CMS doing to reduce healthcare costs? CMS has added observation units which are an additional level of care between inpatient and outpatient.

What Are Observation Units?

In general, observation units are used to bridge the gap between inpatient and outpatient. They are designed for the patient in which the attending physician cannot determine whether a patient should be classified as outpatient (released within 48 hours) or inpatient (expected to stay at least 2 midnights). The observation units enable the physician to have a bit more time to stabilize the patient and based on medical necessity determine the estimated length of stay. They are billed as outpatient and do not count toward an inpatient admission.

Yay or Nay on the ICD-10 Delay?

April 1, 2014

Yesterday the House of Representatives voted on a bill that included a proposal for delaying the implementation of ICD-10 for another year, bringing the compliance date to October 2015. Hospitals nationwide are in the throes of gearing up for the implementation deadline in October of this year, a mere six months away. While some who are not in healthcare may view the delay as a sign of relief, those who have been spending time and money on the implementations are not sighing so much as groaning at the possibility of pushing the deadline out further.

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