Reimbursement

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October 2020
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Think 'outside the blocks' to shore up balance sheets

Editor’s Note: This article from Whitman Partners addresses some ways OR nurse leaders can help their health systems recover from the financial fallout and disruption in normal processes caused by the COVID-19 pandemic. Whitman Partners is a Portland, Oregon-based specialty search firm dedicated to placing directors of surgical services at…

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By: Carisa Brewster
October 21, 2020
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Consider a PSH as a post-pandemic strategy

Across the US, surgical services are estimated to comprise around 20% of national health spending and typically generate up to 70% of total health system revenue.1, 2 That makes surgical services the largest revenue generator for a hospital, supporting access to numerous other healthcare services. Considering the average hospital has…

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By: Barbara McClenathan, MBA-HCM, BSN, RN, CNOR and Lisa Branding, MHSA
October 21, 2020
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CMS threatens to withhold payments from hospitals not reporting COVID-19, flu data

Editor's Note The Centers for Medicare and Medicaid Services (CMS) on October 6 released guidance on how it will implement an interim final rule that requires hospitals and critical access hospitals to report data on COVID-19 and flu patients. CMS says failure to report specified data may lead to termination…

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By: Judy Mathias
October 8, 2020
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CMS issues final inpatient payment rule for FY 2021

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on September 2 issued its final inpatient prospective payment system (IPPS) rule, which will: increase IPPS rates by 2.9% in FY 2021 for hospitals that report quality data and are meaningful users of electronic health records, resulting in an increase…

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By: Judy Mathias
September 8, 2020
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CMS issues emergency regs on daily COVID-19 reporting for hospitals, critical access hospitals

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on August 25 issued emergency regulations requiring all hospitals and critical access hospitals to report daily COVID-19 data. The data includes: number of confirmed or suspected COVID-19 positive patients being treated ICU beds occupied availability of ventilators, PPE, and other…

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By: Judy Mathias
August 26, 2020
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CMS to increase pay to hospitals for care of COVID-19 patients

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on August 17 updated its patient payment guidance to increase hospital reimbursement for care of COVID-19 patients by 20%. The payment increase will take effect September 1. Among requirements for hospitals to receive the Medicare payment increase: Patients must have…

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By: Judy Mathias
August 24, 2020
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What does it take to become an ERAS hospital?

Leaders at Virginia Commonwealth University (VCU) Health System in Richmond started the journey to become an Enhanced Recovery After Surgery (ERAS) hospital in 2016 with the following problem statement: Across surgical specialties, and regardless of superior surgical technique, perioperative care, and anesthesia care, patients can experience extended length of hospital…

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By: Paula Spencer, MSHA, PMP, CPHIMS
August 21, 2020
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ACS opposes proposed Medicare physician fee schedule

Editor's Note The American College of Surgeons (ACS) on August 4 announced that it is strongly opposed to the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule proposed rule for CY 2021. In the fee schedule, which is set to take place January 1, 2021, Medicare payments will…

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By: Judy Mathias
August 6, 2020
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CMS releases 2021 proposed payment rule for ASCs, HOPDs

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on August 4 released the 2021 proposed payment rule for ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). Among the proposals in the rule: CMS proposes to expand the number of procedures that Medicare would pay for when performed…

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By: Judy Mathias
August 5, 2020
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New AHA analysis examines effect of COVID-19 on hospital margins

Editor's Note A new analysis prepared for the American Hospital Association (AHA) by Kaufman, Hall & Associates LLC examines COVID-19’s financial effects on hospitals and healthcare systems. The analysis, released July 21, finds that without further government support, hospital margins in the second half of 2020 could fall to -7%,…

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By: Judy Mathias
July 22, 2020
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