How regulatory shifts are shaping the future of revenue cycle operations
The healthcare industry is set for a major transformation, driven by government policies, legislative reforms, insurance updates and a continuous evolution of compliance and privacy standards that impact revenue cycle management (RCM). These developments present both challenges and opportunities for RCM teams but embracing them is crucial for healthcare organizations to thrive. Key regulatory changes…
Amid tight margins, MedPAC seems set to recommend an additional hospital payment boost
Hospitals have improved financially in the latest reporting period but still should receive a supplementary Medicare payment increase, according to a meeting of the Medicare Payment Advisory Commission (MedPAC). For 2026, Congress should authorize a 1% increase beyond the amount calculated using the statutory methodology, commissioners said during a December discussion. The notion is likely…
As data show a spike in spending on hospital services, new report lays out savings options
Accelerating hospital-focused expenditures helped spur a 2023 increase in national health spending, according to newly released data. Spending on hospital services surged by 10.4% for the year, up from a 3.2% increase in 2022 and 3.4% for the three-year period spanning 2020-22. The 2023 increase was the biggest seen since a 10.8% jump in 1990.…
9 features of a revitalized healthcare workforce
As the 2030s approach, the horizon looks daunting for the healthcare workforce. Consider these trends: The entire baby boomer generation will be eligible for Medicare coverage by the turn of the decade. Clinician shortages are projected to be well into the six figures by 2034, accelerated by a reported exodus of 145,000 clinicians in 2021…
As transparency rules enter their fifth year, advanced uses gain traction
With price transparency rules becoming more entrenched in the healthcare system, applications are growing more sophisticated. “There’s this treasure trove of data out there, and a lot of interest in how it can best be leveraged to support not just consumers but also broader policy goals to improve healthcare affordability,” Sabrina Corlette, JD, co-director of…
Hospital financial and revenue cycle benchmarks paint a complicated picture heading into the new year
The tail end of 2024 has brought promising news regarding hospital financial metrics, even as revenue cycle indicators suggest continuing strain. Margin data are showing moderate improvement, and one of the three credit-rating agencies has upgraded its 2025 sector outlook for not-for-profit (NFP) hospitals and health systems. Fitch Ratings announced this week it was revising…
The state of U.S. primary care: Daunting challenges, achievable solutions
Value-focused efforts to shore up primary care require bold initiatives that increasingly are being implemented but continue to encounter obstacles, according to insights from a recent conference. “We have answers in a kind of amazing array of [physician] practices all over the country that are generally doing an aligned thing,” said Asaf Bitton, MD, associate…
HHS watchdog flags improper payments to hospitals for services provided to hospice patients
Hospitals may face closer scrutiny over a segment of Medicare outpatient billing after the HHS Office of Inspector General (OIG) found improper payments. In a report posted Nov. 18, OIG found that improper payments were prevalent for outpatient services provided to hospice enrollees during a five-year period ending in 2021. Examining a sample size of…
What the site-of-care shift for joint replacement means for hospitals
Hospital patient volumes mostly have been on an upswing since the worst of the COVID-19 pandemic, but certain trends represent cautionary tales for long-term finances. For example, the latest report (registration required) from Strata Decision Technology shows a year-over-year decline in August of more than 21% for inpatient primary knee replacement procedures. A shift to…
Report suggests the extent to which Medicare Advantage health plans are skirting the two-midnight rule
As hospitals struggle with payer tactics involving denials, a new analysis quantifies the extent to which Medicare Advantage (MA) health plans still avoid paying for inpatient care. The report by Kodiak Solutions examined claims data from more than 1,900 hospitals and found that MA plans categorized hospital visits as outpatient observation stays at a rate…