Reimbursement

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April 2021
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Hospitals ramp up outpatient TJA in the COVID-19 era

Fueled by a pandemic, patient demand, and competition with ambulatory surgery centers (ASCs), hospital outpatient department (HOPD) leaders are feeling the push to offer same-day discharge for total joint arthroplasty (TJA). Outpatient TJA is nothing new, but it’s certainly growing in popularity, says John W. Stirton, MD, MBA, medical director…

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By: Jennifer Lubell
March 19, 2021
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Bundled payments with copay waivers reduce surgery costs for patients, payers

Editor's Note A RAND Corporation study published in the March Health Affairs finds that health insurers and patients can achieve significant savings when they participate in a bundled payment program that waives cost-sharing for patients. Researchers examined a bundled payment program developed by a private insurer that ran from 2016…

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By: Judy Mathias
March 2, 2021
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Total hospital admissions down 8.5%

Editor's Note An electronic medical record (EMR) data analysis by Epic Health Research Network for the Kaiser Family Foundation finds that from March through December 2020, hospital admissions were 8.5% below predictions because of COVID-19. The analysis, which is based on Epic’s EMR data on all inpatient admissions from December…

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By: Judy Mathias
February 23, 2021
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More states report telehealth reimbursement laws

Editor's Note A Foley & Lardner survey finds that state telehealth reimbursement laws have significantly increased during the COVID-10 pandemic, but more can be done to address telehealth adoption barriers, the February 15 Revcycle Intelligence reports. More than 43 states and Washington, DC, have some telehealth statute for commercial payers,…

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By: Judy Mathias
February 18, 2021
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COVID-19 has hastened outpatient surgery migration

The latest surge of COVID-19 cases has put many hospitals in a precarious position, with shortages of staff, space, and supplies. Lessons learned earlier in the pandemic cannot necessarily shore up systems that have been overwhelmed with patients. Throughout most of 2020, some patients postponed medical or surgical care. When…

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By: Elizabeth Wood
December 15, 2020
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CMS releases final 2021 Medicare payment rule for ASCs, HOPDs

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on December 2 released its 2021 final payment rule for ASCs and hospital outpatient departments (HOPDs). CMS has finalized the addition of 11 procedures to the ASC covered procedures list, including total hip arthroplasty, autochondrocyte knee implant, and open complex…

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By: Judy Mathias
December 3, 2020
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CMS releases final PFS for 2021, surgeons say rule jeopardizes care

Editor's Note The Centers for Medicare and Medicaid Services (CMS) on December 1 released its 2021 final rule for the Medicare physician fee schedule (PFS), which expands telehealth services and increases payments for primary care and chronic disease management. The rule also reduces payments for surgeons, emergency physicians, and other…

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By: Judy Mathias
December 2, 2020
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Shifts in case mix bode well for future of outpatient surgery

Before COVID-19 emerged as the biggest disruptor of 2020, many ambulatory surgery centers (ASCs) had been growing volume and receiving Medicare reimbursements for an increasing number of procedures. Stopping elective procedures in the spring was a significant setback, especially for smaller, independent facilities, notes a Global Healthcare Advisors (GHA) brief,…

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By: Elizabeth Wood
November 17, 2020
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CMS: How to prepare for COVID-19 vaccine

Editor's Note The Centers for Medicare and Medicaid Services (CMS) on November 5 released a set of toolkits and enrollment actions to take to administer the COVID-19 vaccine when it’s available. Many Medicare-enrolled providers don’t have to take any actions until the vaccine is available. Some Medicare-enrolled providers must also…

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By: Judy Mathias
November 5, 2020
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CMS penalizes 2,545 hospitals for high readmissions

Editor's Note The Centers for Medicare and Medicaid Services (CMS) will penalize and reduce a year’s worth of payments to nearly half of the nation’s hospitals because of 30-day readmission rates, the November 2 Kaiser Health News reports. The penalties are part of the ninth year of the Hospital Readmissions…

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By: Judy Mathias
November 3, 2020
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