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Finance

 

68 percent of patients with hospital bills under $500 didn’t pay off the full balance by the end of 2016, according a TransUnion Health study released at the Healthcare Financial Management Association (HFMA) conference in Orlando.

An ever-changing world of reimbursement can be frustrating for those involved in revenue cycle management (RCM). Being too set in your ways to change, however, is one of the most common strategic mistakes seen by Nicole Rogas, MBA, senior vice president of sales at Experian Health.

Whether Republicans’ version of an Affordable Care Act repeal-and-replace bill looks like the House-passed American Health Care Act (AHCA) or the Senate’s Better Care Reconciliation Act (BCRA), it would have a negative impact on the credit ratings of nonprofit hospitals, according to Fitch Ratings.

Transitioning to value-based care and taking on risk is often cited as one of the drivers of the consolidation trend throughout healthcare. Some systems, however, are beginning to look at partnerships more “holistically,” according to Kaufman Hall managing director Anu Singh, MBA, by pursuing creative affiliations to enhance their capabilities rather than a merger or acquisition.

In a year with new payment tracks for Medicare, additional bumps in the road on the path to value-based care and—potentially—an overhaul of health insurance coverage coming through Congress, what are healthcare finance leaders going to be focused on at this year’s conference?

 

Recent Headlines

CMS proposes 0.25% increase in Medicare Advantage payments for 2018

CMS is offering a more modest 0.25 percent increase in payment rates for Medicare Advantage (MA) insurers, one year after a 0.85 percent hike, in its proposed MA update for 2018. 

Former Tenet exec indicted in $400 million Medicaid fraud case

John Holland, a former senior vice president for Tenet Healthcare’s southern region, has been charged with allegedly taking part in a scheme to pay bribes in exchange for patient referrals and resulting in $400 million in fraudulent Medicaid billings. 

Aetna CEO: ‘No intention’ of being in ACA market for 2018

Aetna CEO Mark Bertolini said the uncertainty surrounding the Affordable Care Act (ACA) and its insurance marketplace is too big of a risk for his company, saying it has “no intention of being in the market for 2018.”

How pulling Healthcare.gov ads could lead to insurer losses in 2017

The administration of President Donald Trump has cancelled advertisements and outreach efforts designed to encourage people to sign up on the health insurance marketplace in the final days of open enrollment, a move which could lead to a sicker, older risk pool for insurers. 

Court freezes CMS rule on premium assistance for dialysis patients

A federal judge has temporarily blocked a CMS rule on requiring dialysis companies to disclose all charitable premium assistance they provide to patients. 

Johnson & Johnson shopping its diabetes care division after cautious 2017 forecast

Three diabetes care units within Johnson & Johnson (J&J) could be sold, the company said, as it reported slightly better-than-expected earnings for the last quarter of 2016 and lowered expectations for the current year.

Federal judge blocks Aetna-Humana deal on antitrust grounds

Aetna’s $37 billion acquisition of Humana has been blocked by a federal judge, who ruled it would violate antitrust laws and seriously limit competition in the Medicare Advantage (MA) market and a handful of health insurance exchanges. 

Radiologists, emergency docs may charge 4 times Medicare rate to out-of-network patients

In a study examining what specialists may charge to out-of-network or uninsured patients, radiologists, neurosurgeons and emergency physicians ranked near the top of the list of highest markups compared to Medicare rates.

 

359,000 clinicians participating in 4 APMs in 2017

CMS has announced which clinicians and accountable care organizations are participating in four alternative payment models (APMs) in 2017: the Medicare Shared Savings Program (MSSP) Next Generation ACO Model, the Comprehensive End-Stage Renal Disease Care Model (CEC) and Comprehensive Primary Care Plus (CPC+) Model. 

Surgical Care Affiliates being sold to UnitedHealth’s Optum for $2.3 billion

Wakefield, Massachusetts-based Optum, owned by UnitedHealth, has agreed to a $2.3 billion cash and stock deal to buy Surgical Care Affiliates (SCA) and its 190 surgical hospitals and ambulatory surgical centers.

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