A week after the D.C. Council awarded multibillion-dollar contracts for insuring D.C.’s Medicaid patients to three insurers, seeming to finally end a years-long struggle to right the city’s Medicaid system after court and council fights, Mayor Muriel E. Bowser has called for a new ethics investigation related to the recently completed procurement.
As the shift to outpatient settings has accelerated, likely due to COVID-19, patient volumes continue to remain below pre-pandemic levels for hospitals and health systems this year, according to a new Kaufman Hall report. The study outlines the barriers that hospitals and health systems face in a year that has been rough financially, with key obstacles such as patient volumes and workforce shortages.
It’s helpful to understand payer-specific contract terms and government billing requirements when developing work lists or work queues and reports. Analyzing data that comes from claim scrubber edits, return to provider edits, variances, and denials can provide insight into repetitive issues that delay the processing of a claim or lead to denials.
A Texas doctor pleaded guilty today for his role in a $54 million scheme to defraud Medicare by prescribing durable medical equipment and cancer genetic testing without ever seeing, speaking to, or otherwise treating patients.
Hospitals are pleading with Congress to postpone looming Medicare pay cuts, citing what they say has been an extraordinarily difficult year. But that unified message belies the fact that hospitals' financial situations vary significantly, and experts say some facilities would be just fine without lawmakers' help.
Policymakers must work with hospital and medical care administrators, as well as health care foundations focusing on children’s health, to ensure enough funding for development of the pediatric workforce. That way, more pediatric resources can become available at more hospitals.
