Journal of Health Care Finance最新文献_第4页

The impact of RAC audits on US hospitals. RAC审计对美国医院的影响。

Journal of Health Care Finance Pub Date : 2013-01-01

Jeffrey P Harrison, Rachel M Barksdale

{"title":"The impact of RAC audits on US hospitals.","authors":"Jeffrey P Harrison, Rachel M Barksdale","doi":"","DOIUrl":"","url":null,"abstract":"The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) authorized a three-year demonstration program using recovery audit contractors (RACs) to identify and correct improper payments in the Medicare Fee-For-Service program. More recently, Section 6411 of the Affordable Care Act (ACA) expanded the RAC program to include the Medicaid program. This shows the Cent ers for Medicare & Medicaid Services (CMS) believe RAC audits are a cost-effective method to ensure health care providers are paid correctly and thereby protect the Medicare Trust Fund. RAC audits are highly complex and require significant manpower to handle the large volume of requests received during a short period of time. Additionally, the RAC audit appeal process is complicated and requires a high level of technical expertise. The demonstration project found that RAC audits resulted in sizeable amounts of overpayments collected (\"take-backs\") from many providers. This research study assesses the potential impact of the RAC audit program on US acute care hospitals. Data obtained from CMS show that RAC overpayments collected for FY 2010 were $75.4 million, increased to $797.4 million in FY 2011, and increased to $986.2 million in the first six months of FY 2012. According to the American Hospital Association (AHA) RACTrac audit survey, the vast majority of these collections represent complex denials where hospitals are required to provide medical record documents in support of their billed claims. This study found that the RAC audit program collections are increasing significantly over time. As a result, these collections are having a significant negative impact on the profitability of US hospitals.","PeriodicalId":56181,"journal":{"name":"Journal of Health Care Finance","volume":"39 4","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31706999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of changes in Medicare payments on the financial condition of nonprofit hospitals. 医疗保险支付对非营利性医院财务状况的影响。

Journal of Health Care Finance Pub Date : 2013-01-01

Dhiman Das

引用次数: 0

The association between health literacy and preventable hospitalizations in Missouri: implications in an era of reform. 密苏里州健康素养与可预防住院之间的关系:改革时代的影响。

Journal of Health Care Finance Pub Date : 2013-01-01

Robert J Cimasi, Anne R Sharamitaro, Rachel L Seiler

{"title":"The association between health literacy and preventable hospitalizations in Missouri: implications in an era of reform.","authors":"Robert J Cimasi, Anne R Sharamitaro, Rachel L Seiler","doi":"","DOIUrl":"","url":null,"abstract":"Objective: To evaluate the association between health literacy and preventable hospitalizations on a population level in Missouri, and the extent to which differing levels of health literacy are associated with county preventable hospitalization rates and associated charges.Data sources/study setting: Secondary data from the 2008 Missouri Information for Community Assessment and Missouri Health Literacy Mapping Tool was used to determine health literacy and preventable hospitalization rates for the 114 counties and city of St. Louis comprising Missouri.Study design: Using correlation analysis, simple hierarchical regression models and nonparametric analysis, we investigated whether lower health literacy rates were associated with increased levels of preventable hospitalizations and charges, by county.Principal findings: Health literacy was found to be inversely associated with preventable hospitalization rates on a population level, accounting for 21 percent of the variation in preventable hospitalization rates. Preventable hospitalization rates significantly differed for counties with the highest and lowest health literacy levels.Conclusions: Lower levels of health literacy are significantly associated with increased rates of preventable hospitalizations and charges in a population-level analysis of Missouri counties. Additional research is needed to quantify the effects of successful community health literacy interventions.","PeriodicalId":56181,"journal":{"name":"Journal of Health Care Finance","volume":"40 2","pages":"1-16"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32138359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Research misconduct oversight: defining case costs. 研究不当行为监督:定义案例成本。

Journal of Health Care Finance Pub Date : 2013-01-01

Elizabeth Gammon, Luisa Franzini

引用次数: 0

The Stark truth: what your physician clients should know about Stark Law and the Anti-Kickback Statute. 斯塔克的真相:你的医生客户应该知道的斯塔克法和反回扣法规。

Journal of Health Care Finance Pub Date : 2013-01-01

Melissa Taormina

引用次数: 0

Hospital philanthropy. 医院的慈善事业。

Journal of Health Care Finance Pub Date : 2013-01-01

Dean G Smith, Jan P Clement

引用次数: 0

Fiscal space for health spending in Southeast Asia. 东南亚卫生支出的财政空间。

Journal of Health Care Finance Pub Date : 2013-01-01

Indrani Gupta, Swadhin Mondal

引用次数: 0

Are physicians profit or rent seekers? Some evidence from state economic growth rates. 医生是逐利者还是寻租者?一些证据来自各州的经济增长率。

Journal of Health Care Finance Pub Date : 2013-01-01

Mary Reilly, Rexford E Santerre

引用次数: 0

The law of unintended (financial) consequences: the expansion of HIPAA business associate liability. 意外(财务)后果法则:HIPAA业务伙伴责任的扩大。

Journal of Health Care Finance Pub Date : 2013-01-01

Jonathan P Tomes

引用次数: 0

Community benefit in exchange for non-profit hospital tax exemption: current trends and future outlook. 以社区利益换取非营利性医院免税:现状趋势与未来展望。

Journal of Health Care Finance Pub Date : 2013-01-01

Simone Rauscher Singh

{"title":"Community benefit in exchange for non-profit hospital tax exemption: current trends and future outlook.","authors":"Simone Rauscher Singh","doi":"","DOIUrl":"","url":null,"abstract":"Assessing the adequacy of the community benefits that not-for-profit hospitals provide in exchange for tax exemption remains a challenge. While recent changes to Internal Revenue Service (IRS) reporting requirements have improved transparency, the lack of clearly defined charitable expectations has resulted in critical scrutiny of not-for-profit hospitals' community benefits and numerous challenges to their tax exempt status. Using data from the revised IRS Form 990 Schedule H for 2009, this article documents the wide range of community benefit activities that not-for-profit hospitals in California engage in and compares them to a set of minimum spending thresholds. The findings show that when community benefit was defined narrowly in terms of charity care, very few hospitals would have met any of the minimum spending thresholds. When community benefit was defined as in the revised IRS Form 990 Schedule H, however, a majority of hospitals in California would have been considered charitable. Whether focusing on expenditures is the most appropriate way to assess the adequacy of a hospital's community benefits remains an open question. To that end, this article concludes by outlining a more comprehensive evaluation approach that builds on recent changes to non-profit hospital tax exemption implemented by the Affordable Care Act.","PeriodicalId":56181,"journal":{"name":"Journal of Health Care Finance","volume":"39 3","pages":"32-41"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31383206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0