“We really do believe much harder times are coming from a reimbursement standpoint”, Daniel Morissette, Stanford Health Care CFO.
With value based model, the most unpredictable payment reform, in their list of financial challenges, CFOs point out their threats and decision making factors.
“We’re trying to evaluate all of the different services we have and evaluate how they will fit into what we believe is the future of healthcare”, Donald Longpre, CFO, North Ottawa Community Health System
“It’s not just the fact that we’re going to get paid less for what we’re doing. We’re also seeing a shift in business,” Chris Bergman, CFO, Christ Hospital Network, Cincinnati. CMS is nipping at little things”, Bergman said on what was worrying him.
When it comes to experience:
“You need to understand the issues, test your theories, and subtly verify your assumptions along the way,” says Tom Gibney, CFO of St. Luke’s Cornwall Hospital of Newburgh, New York, when asked about how experience plays a role in decision making. “The buck stops with you,” he says. “The board is looking to you for answers”, he quoted.
Reimbursement declines, physicians shortage, healthcare reforms and other factors have forced CFO’s to use their experience in answering how to recoup the losses and improve the organization’s cash flow.
We organized the data collected from recent surveys to find out the challenges of healthcare CFOs in a value based era and the factors which influence their decision. Based on the results here’s a data driven answer.
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
CMS pays emergency department visits through a payment method using Ambulatory Payment Classifications (APCs). Most payers also use the APC reimbursement system; however, there may be some differences in payer policies (always review your specific payer policy). APCs are the primary type of payment made under the OPPS, comprising groupings ...
It has been said that the healthcare industry is notoriously slow in terms of technology adoption. One need only look at how convoluted medical coding and billing are to know that it needs a technology injection. Specifically, medical coding and billing software desperately needs artificial intelligence (AI).
Attention providers, suppliers, billers, and vendors who bill Durable Medical Equipment (DME) to Medicare! Currently, a supplier receives a signed Certificate of Medical Necessity (CMN) from the treating physician or creates and signs a DME Information Form (DIFs); these are required to be sent with the claim.
However, this is about ...
Your practice has utilized the same medical billing software for years. The medical billing staff says it is time for a change. You don't necessarily disagree, but you also don't know where to begin your search for new software. There are so many vendors offering so many products that making sense of it all can be challenging.
Each year CMS publishes an Advance Notice of the upcoming years Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and asks for comments related to it. Each of the comments are carefully reviewed and responded to and often are impactful to changes seen between the Advance Notice and final publication referred to as the Rate Announcement. With health equity as a primary focus for 2023, CMS announced some policy changes that may impact your organization.
Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.
We’ve seen a number of OIG risk adjustment data validation (RADV) audits recently where the independent review contractor was simply looking for any codes the payer reported that were not supported by the documentation, in an effort to declare an overpayment was made and monies are due to be repaid. However, it was refreshing to read this RADV audit and discover that the independent review contractor actually identified HCCs the payer failed to report that, while still resulting in an overpayment, was able to reduce the overpayment by giving credit for these additional HCCs. What lessons are you learning from reading these RADV audit reports?
