healthcare and reimbursement

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Medicaid: States' Efforts to Maximize Federal Reimbursements Highlight Need for Improved Federal Oversight

Medicaid--the federal-state health care financing program covering almost 54 million low-income people at a cost of $276 billion in fiscal year 2003--is by its size and structure at significant risk of waste and exploitation. This report addresses how some states have inappropriately increased federal reimbursements; some ways states have increased...

Tags: Healthcare, Medicaid, Reimbursement

White papers 2005-06-28

Medicaid Financing: States' Use of Contigency-Fee Consultants to Maximize Federal Reimbursements Highlights Need for Improved Federal Oversight

Medicaid--the federal-state health care financing program covering nearly 54 million low-income people at a cost of $276 billion in fiscal year 2003--is by its size and structure at risk of waste and exploitation. This document examines the extent to which states are using contingency-fee consultants for projects to maximize federal...

Tags: Healthcare, General Accounting Office, Medicaid, Reimbursement

White papers 2005-06-01

Reimbursement, Specialty Hospitals Weigh Heavy on Minds of CEOs

Declining reimbursement, the threat of specialty hospitals and quality initiatives were top of mind for CEOs. The top concern of CEOs was continuing reimbursement pressures from various payors. A research study shows that the threat of niche providers and specialty hospitals also weighed particularly heavy on the minds of CEOs....

Tags: Specialty Hospital, Healthcare, CEO, Hospital, Reimbursement

White papers 2005-04-01

New Reimbursement Models Reward Clinical Excellence

Pay-for-performance is an emerging payment model that links quality of care with the level of payment for healthcare services. While pay-for-performance programs are still in their formative stages, hospitals need to prepare by intensifying their efforts to ensure systems and processes support high-quality care. In today's healthcare market, complex reimbursement...

Tags: Enterprise Software, Software, Healthcare, Vertical Industries, Benefits, Health Care, Pay-for-performance, Reimbursement, Human Resources

White papers 2004-11-01

Home Care Reimbursement, Long-Term Care Utilization, and Health Outcomes

Long-term care currently comprises almost 10% of national health expenditures and it is projected to rise rapidly over coming decades. A key, and relatively poorly understood, element of long-term care is home health care. The paper uses a substantial change in Medicare reimbursement policy, which took the form of tightly...

Tags: Reimbursement, National Bureau Of Economic Research, Health Care, Long-term Care, Vertical Industries, Healthcare, Benefits, Enterprise Software, Software, Human Resources

White papers 2004-04-01

Outpatient Reimbursement: Complications From Prospective Pay

Medicare hospital outpatient prospective payment system OPPS was implemented affecting hospital outpatient reimbursement with dates of service on or after that date. The new payment system replaced the cost-based reimbursement methodology for outpatient services creating more predictable outpatient revenues. Medicare allowable reimbursement is based on predetermined rates. With OPPS, however,...

Tags: Finance, Operational Accounting, Healthcare, Reimbursement

White papers 2000-12-01

A Case Study of Six Critical Access Hospitals

More than 750 small rural hospitals have been certified as Critical Access Hospitals CAHs since the inception of the Medicare Rural Hospital Flexibility Program in 1997 under the Balanced Budget Act. Despite rapid growth in the number of CAHs and the advantages of cost-based reimbursement and lower staffing requirements, CAH...

Tags: Reimbursement, Hospital, Staffing, Healthcare, Microsoft Access

Case studies

Ambulatory Payment Categories (APCs) : History and Impact on Clinical Coding

The first Medicare payment systems were based on hospital costs and it was subsequently changed to the lesser of costs or charges. The use of codes as the basis for reimbursement revolutionized the coding process. With the implementation of Diagnosis Related Groups in 1984, the need for improved coding became...

Tags: Reimbursement, Payment, Consultant, Training, Workforce Management, Operational Accounting, Healthcare, Human Resources, Finance

White papers

Additional Resources

RemitDATA and Oncology Metrics Partner to Provide Enhanced Benchmarking

Oncology data experts select RemitDATA to automate and analyze remittance data MEMPHIS, Tenn. & DALLAS -- RemitDATA, Inc., a leading provider of web-based productivity tools and benchmarking to the outpatient healthcare market, today announced that Oncology Metrics, a business dedicated to developing products and services to help accelerate...

Articles 2008-08-26

Examine the Fundamentals of Pharmaceutical Pricing and Reimbursement for France in 2008

DUBLIN, Ireland -- Research and Markets (http://www.researchandmarkets.com/research/e73f88/pharmaceutical_pri) has announced the addition of Decision Resources, Inc.'s new report "Pharmaceutical Pricing and Reimbursement in France, 2008" to their offering. Introduction France invests heavily in maintaining its outstanding universal healthcare system. However, drug prices in France -- already among...

Articles 2008-08-21

California Pharmacists Association Applauds District Court Halt of Medi-Cal Cuts

Medi-Cal Beneficiaries Will Continue to Receive Needed Medications, Services SACRAMENTO, Calif. -- A Federal District Court in Los Angeles ordered the state of California to stop the ten percent cuts in Medi-Cal reimbursement payments to healthcare providers. The Court found that pharmacies and other Medi-Cal providers and patients...

Articles 2008-08-20

GHN-Online and TriHealix Announce Partnership for Point-of-Sale Payer Reimbursement and Patient Payment

Collaboration Gives Healthcare Practitioners Proactive and Detailed Visibility into Revenue Cycle DALLAS & NORWALK, Conn. -- GHN-Online, the healthcare industry's leading provider of real-time revenue cycle management solutions, and TriHealix, innovating integrated platforms for medical claims and financial transactions, today announced a partnership that will provide...

Articles 2008-08-20

Medline Launches Prevention Campaign and $1 Million Grant Program to Support Solutions for Hospital-Acquired Conditions

MedlineIndustries, Inc. announced today a new prevention campaign targetingsix hospital-acquiredconditions HACs and the creation of a $1 million research grantprogram to support the adoption of evidence-based solutions in healthcareinstitutions at its Prevention AboveAll forum in Chicago. More than 80 chief nursing officers, chief medical officers and healthcarequality...

Articles 2008-08-18

FirstDoNoHarm.com to Help Healthcare Practitioners and Executives Reduce the Human and Financial Toll Exacted by Hospital-Acquired Conditions

Web Site Provides Prevention, Intervention and Risk-Reduction Resources as Healthcare Industry Prepares for October 1, 2008, Enactment of New CMS Reimbursement Rule for HACs RESEARCH TRIANGLE PARK, N.C. -- FirstDoNoHarm.com has launched new content and resources to support healthcare practitioners and executives preparing for enactment of CMS reimbursement...

Articles 2008-08-18

Arizona Hospital and Healthcare Association Teams Up with ARMSRx to Bring Cost Savings to Hospitals

Arizona hospitals can access the new AzHHA pharmacy benefit program and immediately see improvements to their bottom line PHOENIX, Aug. 18 /PRNewswire/ -- The program was created and is supported by the leading pharmacy benefit consulting firm, ARMSRx, and features transparency, aggressive drug discounts, pass through rebate...

Articles 2008-08-18

Case Studies from Diabetes Medical Home Pilots: Key Processes, Tools, Metrics and Outcomes is Available Now

DUBLIN, Ireland -- Research and Markets (http://www.researchandmarkets.com/research/a46462/case_studies_from) has announced the addition of the "Case Studies from Diabetes Medical Home Pilots: Key Processes, Tools, Metrics and Outcomes" report to their offering. As the patient-centered medical home PCMH model moves from blueprint to implementation, there is some debate over its...

Articles 2008-08-06

Erie County Medical Center's Continuing Care System to Take Quality of Care to New Levels with Voice-Assisted Care

Accuracy improvements will help prepare organization to maximize reimbursements as NY State converts to RUG III PITTSBURGH, Aug. 4 /PRNewswire/ -- Vocollect Healthcare Systems, Inc. announces that Erie County Home, located in Alden, New York, will deploy AccuNurseR voice-assisted care throughout their 586-bed facility. The Erie County...

Articles 2008-08-04

New Report Outlines Seven Major Markets Update for Pricing & Reimbursement Strategies

DUBLIN, Ireland -- Research and Markets (http://www.researchandmarkets.com/research/ce041e/pricing_reimburs) has announced the addition of the "Pricing & Reimbursement - Seven Major Markets Update" report to their offering. Governments and payers across the seven major markets are implementing cost-cutting initiatives to combat escalating healthcare costs, putting even greater pressure on pharma...

Articles 2008-08-01

Alpha II and CPU Medical Management Systems Announce Contract

CPU to interface Alpha II's ClaimStaker with its MED/FM medical billing software system TALLAHASSEE, Fla. -- Alpha II, a leader in healthcare coding, compliance and reimbursement, today announced a contract with CPU Medical Management Systems, a leading provider of healthcare information software to medical billing services and physician...

Articles 2008-07-30

US Oncology Selects RemitDATA to Provide Reimbursement Tools

US Oncology uses RemitDATA to aggregate and analyze claims data MEMPHIS, Tenn. -- RemitDATA, Inc., a leading provider of web-based productivity tools and benchmarking to the outpatient healthcare market, today announced that US Oncology, a company that enhances patient access to advanced cancer care by offering innovative services...

Articles 2008-07-29