HealthLeaders Media Finance - August 16, 2010 | Hospital CFOs as Quality Leaders View as a Webpage | Subscribe for Free
Hospital CFOs as Quality Leaders
Elyas Bakhtiari, for HealthLeaders Media

When Paul Weygandt was presenting to a room full of hospital CFOs about the potential ramifications of the not-yet-passed healthcare reform legislation last year, he asked for a show of hands of how many in the room were involved in their organization’s clinical quality program. Not many went up. [Read More]
 
  August 16, 2010

 
Editor's Picks
CMS OKs 'Medical Necessity' Reviews for RAC
The long wait for medical necessity Recovery Audit Contractor (RAC) reviews will soon be over. CMS has approved the first "medical necessity review" audits for the recovery audit contractor (RAC) program. CMS takes the position that the decision to admit a patient is a "complex medical judgment" made by the patient's physician after consideration of the severity of the signs and symptoms; medical probability of an adverse outcome for the patient; and the need and availability of diagnostic studies. [Read More]
CMS Expands Requirements for PERM, CHIP
CMS has issued final regulations that will implement improvements to the Payment Error Rate Measurement (PERM) for Medicaid and the Children's Health Insurance Program (CHIP). PERM is designed to detect and measure improper payments made in Medicaid and CHIP and then establish a national-level error rates for each program. The reviews are conducted to determine whether sample cases meet applicable Medicaid and CHIP fee-for-service, managed care, and eligibility requirements. [Read More]
Hospitals say more insured patients can't pay
A hospital group says the fastest-growing part of hospital bad debt is money owed by patients who have insurance. As employers dump costs onto workers, so now are workers dumping costs onto hospitals. Total bad debt grew 12%, from $490 million in fiscal 2007 to nearly $550 million in fiscal 2008, at 36 area hospitals that responded to a 2009 survey by the Delaware Valley Healthcare Council of HAP. But bad debt from insured patients grew twice as fast: 28%, from $76 million to $97 million. In a different survey that drew responses from 19 hospitals, the percentage of bad debt attributable to patients with insurance rose from 20% in 2007 to 30% last year. [Read More]
 
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Finance Forum
Medicare Fraud and Abuse Provisions Under the PPACA
President Obama recently signed off on legislation that very likely will result in a substantial increase in lawsuits against health care providers. Intended to combat fraud in the Medicare & Medicaid programs, several amendments in the Patient Protection and Affordable Care Act significantly change the status quo, and will require greater vigilance by healthcare providers in their dealings with the federal government.

[Read More]
 
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Finance Headlines
As reimbursements shrink, heart specialists mull sale to hospitals
Chicago Business, August 10, 2010
CMS awards $5.5M deal for incentive payment services
Government HealthIT/HIMSS, August 13, 2010
Hospital merger prompts lawsuit
The Daytona Beach News-Journal, August 13, 2010
Lawsuit: HMA paid doctors to refer patients to specific hospitals
The Naples News, August 11, 2010
 
 
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Money Talk

A look at one hospital's struggles to improve

Mayo Clinic, Rochester, MN
Rating: AA-
Outlook: Positive
Affected Debt: $1.7 billion
Agency: Standard & Poor's Ratings Services
Remarks: S&P revised its rating outlook to positive from stable and affirmed its AA- rating on various issuers' debt issued for Mayo Clinic. At the same time, S&P affirmed its various other ratings on numerous bonds issued on behalf of Mayo Clinic. Offsetting credit factors include liquidity levels that are still below similarly rated organizations. S&P also considers Mayo Clinic's asset allocation aggressive, with approximately 50% of Mayo's long-term fund in alternative assets. S&P also cites its potential exposure to future Medicare and Medicare physician reimbursement reductions.
[Read More]
 
Audio Feature

Create Extra Capacity, Without Extra Expense: Wayne Keathley, president of New York's Mt. Sinai Medical Center, discusses adding 10,000 patient discharges per year by working on accountability and efficiency in patient throughput. [Listen Now]
 
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