Hospitals, health groups criticize CMS pay proposals
Editor's Note Hospital groups are criticizing CMS' proposed 2.6% pay increase for 2025, deeming it insufficient for nonprofit hospitals with operating margins near or below zero, according to a July 11 article in Becker’s Hospital CFO Report. The American Hospital Association and America's Essential Hospitals argue the rise won't cover…
CMS releases proposed Medicare payment rates for outpatient, ASC services
Editor's Note On July 10, CMS proposed Medicare payment rates for hospital outpatient and ambulatory surgery center (ASC) services for 2025. Published annually, the Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Proposed Rule will have a 60-day comment period, which this year ends September 9 prior to…
Ambulatory endoscopy management strategies keep patients, finances healthy
Gastrointestinal (GI) endoscopy is one of the most common procedures in the US. Performed more than 17.1 million times per year in inpatient and outpatient hospital settings as well as ambulatory surgery centers (ASCs), GI procedures account for 68% of all endoscopies, according to a May 2022 article in Digestive…
Large amounts of personal data possibly stolen in Change Healthcare cyberattack
Editor's Note Personal information about a “substantial portion of people in America” could be at risk from the February 21 cyberattack on UnitedHealth’s Change Healthcare division, The Associated Press reported April 23. Although the company reports no signs of full medical histories or charts were released, notifying all who were…
Getting ready for the OAS CAHPS Survey 2025 requirement
Editor's Note Starting in 2025, Medicare-certified ambulatory surgery centers (ASCs) will be required to participate in the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey to comply with the ASC Quality Reporting Program, reports the Ambulatory Surgery Center Association (ASCA) and Outpatient Surgery Magazine…
Survey assesses continued impact of Change Healthcare cyberattack
Editor's Note Fallout from the February 21 cyberattack on Change Healthcare continues to threaten physician practices and their patients nationwide, with respondents to a recent American Medical Association (AMA) survey indicating difficulties with insurance claims and eligibility verification. AMA published the results of the informal survey April 10. Conducted March…
Concierge physician practices expanding to large hospitals
Editor's Note The practice of concierge physicians is expanding as thousands of doctors at large hospital systems shift to a model facilitating high fees and decreased patient load, according to an April 1 report in KFF Health News. The concierge physician model began decades ago in wealthy areas of Florida…
Private payers profit by delaying medical claims
Editor's Note Private payers initially deny reimbursement on 15% of claims, only to later approve more than half of those initial denials, according to a national survey of healthcare institutions published March 21 by Premiere, Inc. Additionally, the denied claims on average tend to be more prevalent for higher-cost treatments…
How data puts the ‘value’ in value-based care
What if a surgeon decided to perform a procedure on a patient that was not totally necessary? It happens more often that one might realize. As recently as August 2023, Forbes published an article that cited a Harvard Business Review report stating that over 50% of lumbar spine surgeries are…
Medicare offers advance payments for providers impacted by Change Healthcare cyberattack
Editor's Note In a March 9 Press release, CMS announced it will offer emergency funding for healthcare providers experiencing continued disruptions in the wake of a February 21 cyberattack on Change Healthcare, a subsidiary of UnitedHealthGroup and a major processor of medical claims. According to the release, CMS will extend…
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