Articles Tagged With: payment
-
Uncertainty Over Health Plan Coverage Affects EDs
Patients are right to worry about out-of-pocket costs or whether their health plan will cover the visit. An expert explains more about what this means for EDs and about the current state of reimbursement for ED visits.
-
Many Patients Worried Health Plan Will Not Cover ED Visit
Patients, not staff, should initiate discussions regarding payment for services. Train staff to carefully document discussions with patients regarding billing or payment questions. Ensure staff members understand patients are never implicitly discouraged from seeking emergency care in the ED.
-
Paying Participants? Incentives Should Be Reasonable for Research Activities Involved
Remember two central ethical concerns: Undue inducement, meaning an offer so attractive it leads to bad judgment, and unjust inducement, meaning payment is more attractive to lower-income people, putting too much of the burden of research participation on them.
-
Denial Prevention Tactics Are Front End-Focused
Revenue cycle departments spend lots of time and money appealing denied claims. However, some hospitals are diverting resources to the front end instead. -
Surprise Bill Legislation Means Big Changes for Patients and Hospitals
“Bad news travels fast, and good news travels more slowly ... It’s a major problem, and it will take years to unwind the anxieties that have been created.”
-
Denials Categorized Based on Complexity
Some denials can be overturned easily — maybe a piece of clinical documentation is missing. Other denials are a long shot, requiring lots of time and effort to challenge. For one Philadelphia-based health system, no mountain is too high to climb.
-
Revamped Tactics Needed to Overturn Surge of Denied Claims
Forced to invest significant resources trying to overturn all these denials, patient access departments are searching for the most efficient and effective way to do it.
-
Is It a Problem to Pay Research Participants?
Paying people to participate in clinical research can be seen as ethically problematic. Yet community members expressed the opposite view, according to the results of a recent study.
-
If CPT Code Changes, Patient Access Can Obtain Payment
Patient access can intervene to stop an unauthorized test, assuming it is not emergent or urgent — or find out if the patient wants to go forward anyway. Registrars' expertise makes all the difference on whether the hospital is paid, and how quickly. Possibly, the health plan will agree a new authorization is unnecessary — as long as the clinical records are sent with the claim.
-
The Basic Elements of Healthcare Reimbursement, Part 3
In this month’s issue, the conversation on healthcare reimbursement turns to the additional prospective payment systems found across the continuum of care. Prospective payment remains a way in which the Centers for Medicare & Medicaid Services can determine the rates for care based on predetermined amounts rather than on billing. The processes are similar to the use of the diagnosis-related groups in the acute care setting, with some differences.