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Staying on top of hospital revenue cycle news is no small task—especially during the busy holiday season. That’s why we’ve done the work for you. Check out these four recent newsworthy stories that could impact your hospital in the near future.

 

Most hospitals will receive a positive value-based payment adjustment in fiscal year 2020

The results of the CMS hospital value-based purchasing program are in, and the good news is that the majority of hospitals (55%) are on the plus side with the highest-performing hospital receiving a 2.93% positive payment adjustment. As expected, the bad news is that some hospitals will see a negative payment adjustment with the lowest-performing hospital incurring a net decrease in payments of -1.72%. How does your hospital’s value-based payment adjustment compare? Is it time for a financial tune-up?

 

Hospitals required to make standard charges public in 2021

CMS finalized a rule requiring hospitals to provide healthcare consumers with information about facility-specific standard charges (i.e., gross charges, payer-specific negotiated charges, the amount the hospital is willing to accept in cash from a patient, and the minimum and maximum negotiated charges) starting in 2021. Organizations must provide this information in two ways:

 

1.      Comprehensive machine readable file that includes medical coding information and a description of the item or service

2.      Display of shoppable services in a consumer-friendly manner

 

The civil monetary penalties for noncompliance will be steep: $300 per day. What is your organization doing to prepare for greater transparency? How will you avoid consumer confusion? A trusted coding partner can help.

 

Blue Cross Blue Shield of Massachusetts partners with PillPack by Amazon Pharmacy to improve the customer experience

Blue Cross Blue Shield of Massachusetts recently announced it would partner with PillPack by Amazon Pharmacy to help members taking multiple daily prescriptions better manage their medications. Among PillPack’s many services include a 30-day supply of pre-sorted mediations delivered to members’ doorsteps, customed dosing packaging, 24/7 access to pharmacists, and more. Could this type of partnership enhance medication adherence while also improving the patient experience? And more importantly, what’s the ‘lesson learned’ for healthcare organizations seeking to move the needle on reducing readmissions and improving clinical outcomes?

 

Out-of-network care at in-network hospitals costs the industry $40 billion annually

Using 2015 data from a large commercial insurer, researchers at Yale University found that out-of-network providers (specifically anesthesiologists, pathologists, radiologists, and assistant surgeons) providing care at in-network hospitals billed higher negotiated rates that translated to $40 billion in healthcare spending. The study abstract states the following: ‘When physicians whom patients do not choose and cannot avoid can bill out-of-network for care delivered within in-network hospitals, it exposes patients to financial risk and undercuts the functioning of health care markets.’ Healthcare organizations beware: The push for greater pricing transparency and a reduction in surprise medical bills could shift the tides. How might these changes affect your revenue?

 

New CPT revenue opportunities take effect January 1

A whole slew of new CPT codes take effect January 1, some of which could be revenue opportunities for system-owned physician practices. In particular, there are six new CPT codes for e-visits, five new CPT codes for health and behavior assessment and intervention, and two new CPT codes for home blood-pressure monitoring. Is your coding vendor up-to-date on these changes, and can it help you ensure coding compliance?

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