Penalties and Pain Points: The CMS 2018 PBJ Updates

The Centers for Medicare & Medicaid Services (CMS) made several changes to the Payroll-based Journal (PBJ) system this spring, including new penalties for not meeting the submission requirements. Does your staff have a clear understanding of what the damage will be to your organization’s Five-Star ratings if the new guidelines aren’t followed?

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Is your workflow impeding revenue?

The reimbursement landscape is changing, and healthcare organizations can’t keep up with outdated or flawed systems and processes. The days of Medicare and Medicaid comprising the majority of revenues are fading fast. Today, private/commercial insurers and patients make up a greater percentage of payments.

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Consumerism: The New Patient Mindset

Consumers have become more engaged with their healthcare systems as they accept a greater share of the cost for their care. Just as they depend on social media and online reviews to gather and share information about travel, restaurants and shopping, consumers are now sizing up healthcare providers based on their experience throughout the care and billing cycle. Read more

Growth in Medicare Advantage Surprises Even Experts

With so much turmoil in healthcare these days, Medicare Advantage (MA) is proving a bright spot for payers and patients, although many healthcare organizations have administrative headaches in working with these plans. MA plans are here to stay – the number of plans has grown by 14 percent in 2018 over the previous year!

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Income Tax Refunds Spike Patient Healthcare Spending

New research shows patient spending on healthcare spikes during the tax-refund season, especially for ambulatory care. A study reveals that patients immediately seek appointments and services after receiving refunds. Also noteworthy: they use refunds to pay down outstanding balances. Read more

Rising Deductibles Drive More Patients to HSAs

If patients get sticker shock on their health plan deductibles in January, it’s bound to be contagious. Providers trying to collect payments in the new year are likely to catch it, too.

The calendar rollover in January can be a wake-up call for consumers as they again become responsible for paying every healthcare dollar up to their deductible threshold. Patients who don’t realize the reset occurred may be surprised by the first bill of the new year. They are on the hook for more than ever. Read more

New A/B MAC Selected for Jurisdiction J – Alabama, Georgia and Tennessee

The Centers for Medicare & Medicaid Services (CMS) has announced it will transition the A/B Medicare Administrative Contractor (MAC) for three states (Jurisdiction J) in early 2018.

Palmetto GBA will become the new MAC (replacing Cahaba GBA) in Alabama, Georgia and Tennessee, as well as for any additional out-of-jurisdiction or RHC providers who currently submit to Cahaba GBA. Transition dates are Jan. 29, 2018, for Part A providers and Feb. 26, 2018, for Part B. Read more

Open Enrollment Sets Up a Challenging January 2018

Providers will be on the front lines come January, as the wheels are in motion for confusion and sticker shock during open enrollment this year. Most Americans will face at least a ripple of anxiety or new cost pressures as they grapple with year-end decisions and 2018 realities. Payers have scrambled to anticipate and minimize their risk amid the turmoil of 2017, and provider practices and organizations are where the rubber will meet the road next year. Read more