Biden Administration Cracking Down on Nursing Home Safety

The Biden administration is promising an effort to improve safety and quality of care in the nation’s nursing homes. The fact sheet foreshadows substantially stiffer oversight and harsher enforcement.

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.

Underpayment Is Major Concern for EDs with New Surprise Billing Law

This landmark consumer protection took effect Jan. 1, but litigation from advocacy groups is pending as insurers are jockeying with providers for reimbursement rate advantages.

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.

COVID-19-Specific Codes Can Maximize Reimbursement

As many hospitals continue managing COVID-19 patients, six new ICD-10 codes will help facilities obtain reimbursement.

Controversial ‘Public Charge’ Rule Under Further Review

Scrutiny on DHS policy that targeted immigrants using government benefits such as Medicaid.

Acupuncture as a Pain Management Alternative

The goal is to provide data that will convince payors to reimburse acupuncture treatment in the emergency environment, a stumbling block that has thus far prevented larger-scale implementation. Additionally, researchers hope their work leads to fewer unnecessary opioid prescriptions.

CMS Finalizes 2021 Physician Fee Schedule, Tinged with a Bit of Controversy

A budget neutrality provision leads industry groups to cry foul over Medicare cuts.

The Basic Elements of Healthcare Reimbursement, Part 2

This month will continue the discussion of healthcare reimbursement by third-party payers. We began last month with a review of the diagnosis-related groups (DRGs) and associated terminology. We will continue by reviewing how medical records are coded followed by the new MS-DRGs implemented in 2007.

When Insurers Will Not Pay for Service Performed at a Hospital

It is not enough anymore to demonstrate that a surgery or imaging test is medically necessary. To receive reimbursement from health plans, patient access staff also must prove it is necessary for the procedure to happen at a hospital.

Articles Tagged With: reimbursement