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Jun 9, 2017 9:00:00 AM

Activity-Based Costing: The Rock Star of Payment Model Reform

Think you can’t afford to invest in a cost-accounting system? The truth is, you can’t afford not to. As Medicare and other payers increasingly tie payments to value, understanding and reducing your cost structure will become an even more urgent priority.

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Topics: Medicare, Cost Accounting, Payment Model Reform

May 25, 2017 10:00:00 AM

A Prescription for Reviving Your Financial Outlook: A Medicare Risk Strategy

Healthcare providers face $42 billion in cuts in 2018 under Medicare’s traditional fee-for-service program. Those payment rate reductions, which were put in place by the Affordable Care Act, are scheduled to cut deeper with each year—from $53 billion in 2019 to $86 billion in 2022.

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Topics: Medicare, Fee-for-Service, Value-Based Pay

Mar 31, 2017 10:00:00 AM

3 Insights from AHLA’s Institute on Medicare & Medicaid Payment Issues

Last week’s sudden pull of the American Health Care Act from House vote caused uncertainty around what’s next for the healthcare industry. This week, the AHLA Institute on Medicare and Medicaid Payment Issues, brought together key representatives from CMS, hospital associations and healthcare lawyers from around the nation. Here are three Medicare/Medicaid insights on current and upcoming issues:

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Topics: Medicare, AHLA, CMS, Medicaid

Jan 5, 2017 10:30:00 AM

Medicare-Medicaid ACO Model: Urge Your State to Apply by Jan. 20

January 20 is a significant date for healthcare providers—but not necessarily for the reason you think.

Yes, there is the inauguration of the 45th President of the United States, who has vowed to “repeal and replace” the most significant healthcare legislation in recent history.

But that date has even greater significance for the many providers across the country who are struggling to cover the cost of care of an increasingly high-risk, low-income population.

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Topics: Medicare, ACO, Medicaid

Dec 8, 2016 11:00:00 AM

Will MACRA Fall Victim to Repeal and Replace?

I've just returned from the National MACRA MIPS/APM Summit in Washington, D.C., where the overarching discussion centered on how to create and implement strategies that pay physicians fairly, while controlling spending in the Medicare program. It's a question we've wrestled with for almost 20 years and a challenge we must solve.

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Topics: Medicare, MACRA, CMS, MIPs, APMs

Apr 15, 2016 11:30:44 AM

3 Key Takeaways from AHLA’s Institute on Medicare and Medicaid Payment Issues

As I think about the healthcare industry and where we’re headed, I’m reminded of a lyric from the Tracy Lawrence song Time Marches On, “The only thing that stays the same is everything changes, everything changes.” Serious change is afoot and providers cannot just keep their heads above water. They have to find a way to thrive and flourish.

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Topics: Medicare, AHLA, Site-Neutral Payment, Financial Reporting

Feb 25, 2016 10:00:00 AM

What You Need to Know About MACRA and FMV

Although physicians around the country cheered the permanent repeal of the sustainable growth rate (SGR), the resulting reimbursement and payment model changes could significantly impact the fair market value of physician practices. The passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changed the valuation environment significantly. The HORNE Healthcare team has been researching the changes, and here is what you need to know:

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Topics: Medicare, Physician Compensation, FMV, MACRA

Jul 31, 2015 10:00:00 AM

Medicare Turns 50 Amidst Serious Challenges

Medicare turns 50 this week with a number of substantial challenges in its future, and its overall success may be one of the largest contributing factors. When Medicare was created in 1965, nearly half of all seniors in the United States were uninsured. The program covers 55 million people today, providing medical care to one in every six Americans.

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Topics: Medicare

Sep 25, 2014 10:30:00 AM

Long-Term Care Hospitals: Prepare NOW for Medicare Changes

There are some upcoming Medicare reimbursement changes for long-term care hospitals that require immediate attention.  What makes this change so important? In a nutshell, it may take awhile to figure out the impact on revenue and you need time to gather data and plan for the rule changes. 

The Centers for Medicare and Medicaid (CMS) has made no secret of the fact it feels  there have been abuses in the long-term care hospital arena and that’s why it is ramping up payment reductions and changing the rules. The CMS will be changing which patients qualify as long-term care hospital patients, and only certain types of patients will be paid at long-term care hospital rates beginning in 2016. 

The rule change for long term care hospital payment rates 

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Topics: Medicare, Long-Term Care

Aug 7, 2014 10:30:00 AM

Hospital CFOs Still Seeking Clarity About Allina DSH

Are you wondering about the status of your Medicare Disproportionate Share Hospital (DSH) payments in light of the recent Allina DSH court ruling? You’re not alone.  An April 2014 ruling from a U.S. Court of Appeals for the District of Columbia Circuit upheld a previous ruling that a Health and Human Services (HHS) rule change in 2004 (codified in 2007) was procedurally defective. The lawsuit had to do with a rule change the HHS made to determine DSH payments in 2007. The hospitals claimed there was not proper notification. Although the court ruled favorably for the hospitals, what happens next is still unknown. 

The appeals court included instructions in the ruling that gave the HHS room to reach the same policy decision through administrative adjudication. The bad news for providers is that adjudicatory findings can be applied retroactively. The Centers for Medicare and Medicaid Services (CMS) has not yet issued a definitive guideline on how to retrofit the reimbursement fractions for the years in question. 

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Topics: Regulations, Medicare