The healthcare industry has undergone major changes since the rollout of the Affordable Care Act and now a new type of reimbursement model is putting traditional incentive based payment models on the shelf for good. Value based reimbursement, which ensures that providers are rewarded for performance, quality, and cost reduction (instead of number of services provided), is a model that will help shape the future of healthcare.
A new study sheds light on another repercussion of the opioid epidemic, and how it is adding to the nations ballooning health care costs and who is shouldering that burden.
The Centers for Medicare & Medicaid Services is testing some new reimbursement and payment models for drugs, some of which mirror models currently used in the private sector. Medicare hopes working with providers, like many private payer networks, will lead to more efficiencies in prescriptions and eventually to lower costs.
The role of the Independent Review Organization (IRO) in the appeals process is to provide an unbiased 3rd party opinion on complicated reviews, helping to assure that all reviews are given the time and care they deserve. It’s a common illusions in the healthcare industry that taking care of things in house is the best and easiest way to save money—however this isn’t true when it comes to claim reviews. If you are trying to manage your denials in-house, it can actually be counterproductive if you’re trying to save money and even time. Let’s take a look at how outsourcing your IROs can save you time and money.
Moving into a realm usually reserved for health care regulators, the California health marketplace Thursday unveiled sweeping reforms to its contracts with insurers, seeking to improve the quality of care, curb its cost and increase transparency for consumers. The attempt to impose quality and cost standards on health plans and doctors and hospitals appears to be the first by any Obamacare exchange in the nation. Among the biggest changes: Health plans will be required to dock hospitals at least 6 percent of their payments if they do not meet certain quality standards, or give them bonuses of an equal amount if they exceed the standards.
It’s only the beginning of 2016 but here at BHM Healthcare Solutions we have been keeping a close eye on the upcoming healthcare trends for the year. So far we’ve discussed the important trends of Pharmacy and Behavioral Health and how each of those industries is expected to make great strides in the New Year.
Rural Hospitals Face Financial Pressure according to a recent article
MOUNT VERNON, Texas—Despite residents’ concerns and a continuing need for services, the 25-bed hospital that served […]
The Affordable Care Act (ACA) has begun to revolutionize healthcare, but even bigger changes are on the way, and those in the Hospital industry are dealing with everything from an increased emphasis on customer satisfaction to decreased reimbursement and rapidly changing payment models. Find out the critical components you need to know to be successful in the new healthcare environment. Join us 12/19 for the free webinar The Affordable Care Act - Impact on Hospitals & Healthcare.
With new advances in the way medical information is transcribed, stored and transferred, technology has created more variables to a provider’s success than ever before. Between tangling with mountains worth of paperwork, handling claims denials and riding the learning curve of new systems like EHRs and ICD-10 coding, there can be lots of room for error and, consequently, potential revenue that slips through the cracks. Luckily, revenue cycle management systems are here to help. They can streamline a vast array of your most intensive processes — like admitting, coding, balancing budgets, billing and filing claims — in order to provide a supreme level of oversight and control. This control in turn helps you avoid common RCM problems that lead to lost revenue, profitability and productivity.
