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Aug. 8, 2019
              FHIweekly               
Volume X  |  Issue 32       
Myth Diagnosis: Do hospitals charge more to make up for low government pay?
Shannon Muchmore Healthcare Dive

It's a mantra from providers to justify the disparate prices charged patients depending on their level of insurance coverage: It's all in the name of cost shifting to make up for stingy government reimbursement. The idea is that hospitals bill commercial payers more to make up for low rates from government payers and the costs from treating the uninsured. Providers and payers both insist the practice occurs, but academics are skeptical - and the notion is notoriously difficult to measure.
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CMS wants to force hospitals to reveal negotiated rates. Can it do that?
Samantha Liss reports for Healthcare Dive:

The Trump administration believes it has the authority to compel hospitals to reveal secret pricing information tucked into their contracts with insurance plans, but the case isn't entirely clear-cut. A legal challenge to the proposed rule requiring the disclosure from hospitals and insurance companies is likely, and experts are split on the odds payers and providers could beat back the effort in court. Hospitals and insurers are loathe to share payer-specific negotiated prices, arguing it would harm patients in the form of higher prices or limited access to care. Payers believe it would create a floor for hospital prices, encouraging any hospital being paid less to demand higher reimbursement, while hospitals argue it will fuel anticompetitive behavior among payers and reduce access to care.
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The importance of a comprehensive Revenue Cycle Management system
MK Medical Solutions Blog
As healthcare policy and insurance payment methodologies evolve, payor denials are increasing. Some of the most common reasons are that the claim was submitted with incorrect patient demographic data,
Image Credit_ Dynamas2002
Image Credit: Dynamas2002
incorrect CPT code and/or diagnosis, missing preauthorization or referral, patient benefits expired prior to the date of service, service not covered, incorrect place of service, and hundreds of other reasons. Payors are driven to cut cost  by denying claims, implementing rigorous appeals processes and stringent payment policies. This methodology leaves providers and healthcare systems to adhere to administrative hurdles of capturing maximum reimbursement while sifting through payment policies, regulations and appeals processes. EMR & EHR systems have greatly aided providers in managing the RCM process better; however, practices shouldn't rely solely on the technological advances for all capabilities. It is in the best interest of health systems to examine all aspects of their AR and RCM processes, starting with the patient access points of entry, leading to billing, reimbursement and collection, to reconciling data, to reporting, and lastly to the most important aspect of the practice, the patient experience. 
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Is Our Health Care Spending Actually Worth It?
Aaron Carroll, MD, MS

Many people know by now that the United States spends much more on health care than any other country, and that health outcomes are not a lot better (and in many instances worse). That raises the question: Is our health care spending actually worth it?
Many people know by now that the United States spends much more on health care than any other country, and that health outcomes are not a lot better (and in many instances worse). That raises the question: Is our health care spending actually worth it?

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