News & Analysis

September 1, 2016
HIM Briefings

The cost of healthcare is quickly rising across the nation, and patients are shouldering the majority of the price increases through higher deductibles and out-of-pocket expenses as expenditures continue to shift from employers to patients. According to a TransUnion Healthcare report released during HFMA's 2016 National Institute in Las Vegas (www.marketwired.com/press-release/-2137926.htm), patients experienced a 13% increase in medical costs between 2014 and 2015.

A rise in self-pay patients usually signifies an increase in bad debt risk that can have a sharp and negative effect on revenue streams. As expected, healthcare organizations responded to this upward trend in patient financial responsibility by dedicating more attention and resources to managing their self-pay accounts. But are additional complications necessary? Can self-pay accounts be managed more effectively by actually taking fewer and more logical steps?

Recent work with pre-acute care providers, such as emergency medical services (EMS) and emergency medicine physician groups, reveals that most of these providers are struggling to address self-pay accounts. Hospitals and health systems report similar concerns. Addressing the rise in self-pay patients requires a shift change in revenue cycle management strategies and tactics.

Instead of raising the level of complexity required to manage self-pay receivables, providers should try to simplify efforts?work smarter, not harder. Determining patient propensity to pay is one of these practical steps. Using the pre-acute care sector as one example, qualification for accounts management can be radically simplified with significantly fewer steps.

September 1, 2016
HIM Briefings

CMS is looking to implement the Section 603 provisions of the Bipartisan Budget Act of 2015 regarding off-campus, provider-based departments (PBD) by January 1, 2017, according to the 2017 OPPS proposed rule (https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-16098.pdf). The agency is proposing to pay the nonfacility or office Medicare Physician Fee Schedule (MPFS) amount to the performing/supervising physician and preclude hospitals from billing on a UB-04 form or receiving OPPS payment for services performed at these locations for 2017, but plans to explore other options for 2018 and beyond.

Physicians would be paid at the higher nonfacility rate of the MPFS, but only hospitals that have employed or contracted physicians that reassign their billing to the hospital would get paid under the MPFS for these services.

Hospitals would be able to bill claims on CMS-1500 forms for physicians who have already reassigned their billing to the hospital, as in the case of employed physicians. Otherwise, hospitals would have the option of enrolling the location as the type of provider or supplier it wishes to bill to meet the requirements of that payment system (e.g., ambulatory surgery center or group practice).

"This proposal will be very challenging for hospitals that have community physicians practice at their off-campus outpatient departments that will no longer be paid under OPPS," says Valerie Rinkle, MPA, lead regulatory specialist and instructor for HCPro, a division of BLR, in Middleton, Massachusetts.

"These physicians would bill with the office place of service code and the hospital would have to figure out how to get compensated," she says. "This will likely require hospitals to rewrite their agreements with these physicians."

September 1, 2016
Briefings on APCs

CMS’ proposed changes to implement Section 603 of the Bipartisan Budget Act of 2015 would reshape payments for off-campus, provider-based departments (PBD) if finalized and represent the most significant changes in the calendar year (CY) 2017 OPPS proposed rule. 

September 1, 2016
Briefings on APCs

While the 2017 OPPS proposed rule includes a variety of tweaks and augmentations to existing regulations, its biggest impact is likely to come from its proposal to implement Section 603 provisions of the Bipartisan Budget Act of 2015 regarding off-campus, provider-based departments (PBD) and move toward more site-neutral payment policies.

September 1, 2016
HIM Briefings

The accurate capture of acute respiratory failure has been a long-standing challenge for CDI programs. The accurate reporting of this condition as a post-procedural event can be even more difficult.

September 1, 2016
Briefings on APCs

 CMS proposes aligning its conditional packaging logic with how it applies packaging to labs, while also proposing to delete the much-maligned modifier -L1 for separately payable laboratory tests in 2017.

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