Here’s a sampling of the recent articles R1 revenue cycle experts are reading:
Becker’s Hospital Review
We’re going to have to fix this ourselves
Medicare Advantage now exceed traditional Medicare for coverage, but some hospitals and health systems are choosing to end contracts with some MA plans due to administrative hurdles. The most frequently cited challenges include high prior authorization denial rates and delayed payments from insurers.
Health Leaders
Provider CFOs bristle at payer ‘dirty tactics’
Friction between health systems and payers has worsened over the past three years, a new HFMA survey finds, with 80% of provider CFOs accusing the plans of “intentional or systematic efforts to increase denials.” So, it’s no surprise that nearly 60% say payer relationships are deteriorating.
Becker’s Hospital Review
Health systems brace for possible 340B cuts
Many hospitals across the nation rely on the 340B program to stay afloat amid challenging financial times. But that could change significantly in the next few years. Legislators have their eye on 340B and pharmaceutical companies are trying to make changes. Earlier this year, the bill H.R. 8574, the 340B Affording Care for Communities and Ensuring a Strong Safety-net Act, was introduced in the House of Representatives, which would narrow the beneficiaries of the 340B program.
RACmonitor
Malfeasance – A two-way street?
We have been talking a lot lately about the malfeasance of Medicare Advantage (MA) plans, and deservedly so. But malfeasance can be a two-way street. Last week, the Lown Institute released data on unnecessary back surgery. From their analysis of Medicare and MA data, more than $2 billion was spent on such surgeries over a three-year period.
