Healthcare Digest

News, Information, and Trends in the Healthcare Industry

April 2025 / Volume 4 Number 4

April 12, 1861: Confederate forces fire on Fort Sumter in South Carolina, thus beginning the American Civil War. The war that defined our Nation.

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The Medicaid Fight

How hospitals are fighting to protect Medicaid

Nicole Stallings, President and CEO of the Hospital and Healthsystem Association of Pennsylvania, joined the Becker’s Healthcare Podcast to shed light on the challenges ahead — chief among them, the battle to protect Medicaid.

Medicaid State Fact Sheets

Medicaid and the Children’s Health Insurance Program (CHIP) provide health and long-term care coverage to almost 82 million low-income children, pregnant women, adults, seniors, and people with disabilities in the United States. Medicaid is a major source of funding for hospitals, community health centers, physicians, and nursing homes. States operate their Medicaid programs within federal standards and a wide range of state options in exchange for federal matching funds.

Health system CFOs fight for Medicaid on Capitol Hill

Multiple health system CFOs recently traveled to Washington, D.C., to meet with lawmakers on Capitol Hill, advocating against proposed Medicaid cuts that could threaten access to care and lead to the closure of essential hospital services.

Health system executives participating in these discussions included.

A Key Stretch for Urging Congress to Protect Medicaid and Access to Care

Congress is back in Washington, D.C., for a critical three-week stretch in which House and Senate Republicans are seeking to strike a compromise on a common budget resolution that would allow them to start the budget reconciliation process to push through priorities on taxes, border security, energy and deficit reduction.

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Microsoft says 550 hospitals have joined rural cybersecurity program created with AHA

Microsoft March 5 announced that 550 rural hospitals have joined the Cybersecurity for Rural Hospitals Program, an initiative created last year in partnership with the AHA that includes free and heavily discounted cybersecurity services. It also includes nonprofit pricing for qualifying critical access hospitals on Microsoft enterprise licenses. Visit the registration page to learn more and sign up for the program.

Hospitals and health systems receive fake data extortion letters

In recent days, the AHA and the FBI have received multiple reports of hospitals and health systems receiving data extortion letters delivered through the U.S. Postal Service and originating domestically. The letters mostly purport to be from the Russian ransomware group known as BianLian.

Memorial Hermann given rare ‘not in good standing’ designation following liver transplant scandal

The Organ Procurement and Transplantation Network’s board of directors on Feb. 20 declared the Houston hospital as a “member not in good standing,” the most severe action that the network can take against one of its member hospitals.

CMS Innovation Center Announces Model Portfolio Changes to Better Protect Taxpayers and Help Americans Live Healthier Lives

The CMS Innovation Center will terminate four Medicare payment models early in a move that aims to save nearly $750 million and shift focus to more viable approaches to value-based care.

The models set to end by Dec. 31, 2025, include:

• Maryland Total Cost of Care (originally scheduled to run through 2026)
• Primary Care First (2021-2026)
• End-Stage Renal Disease Treatment Choices (2021-2027; will require rulemaking for termination)

ASCs vs. HOPDs: Why independence has the upper hand

As ASCs continue to grow in popularity, they face increasing competition from hospital outpatient departments. 

Alejandro Badia, MD, founder and CMO at Miami-based Badia Hand to Shoulder Center, joined Becker’s to discuss how ASCs can differentiate themselves from HOPDs. bladder.

The ‘shifting pendulum’ of physician independence

The decision between ownership and employment remains one of the most critical career choices for physicians, particularly as reimbursement strains and practice costs push some in the workforce toward employed models. bladder.

Physicians branch out from hospital employment to start independent group

Nine physicians from the New England Heart and Vascular Institute at Catholic Medical Center are branching out to establish Cardiovascular Specialists of New England, an independent practice, the New Hampshire Union Leader reported Feb. 29.

Emergency Room "Live" Support

Emergency Departments are a significant source of a facilities’ pure self-pay inventory as well as a continuing challenge to compassionately serve the patient while obtaining vetted patient demographic and insurance information for successful 1st. pass billing.  Our service engages post EMTALA and are fully compliant.

First "48"

Our protocol focuses on contacting the patient in and around 48 hours of the patient exiting the Emergency Department. Through direct experience we have found this to be the optimum time to communicate with the patient, solidify payment arrangements, catch and correct any insurance information or correct the financial class. 

Objectives;

• Payment Arrangements that are set up this close to services rendered have a much better payment to term success. All payment
• Vetted Insurance & demographic information – before it hits billing thereby increasing successful 1^st pass billing and payment.
• Improve patient relations. – catching errors at the beginning of the revenue cycle, will reduce adverse patient reactions later in the revenue cycle.
• Improve the Emergency Department’s patient services and efficiency.

Dedicated healthcare representatives;

• Representatives focused in this endeavor.
• Procedures tailored to your in-house financial policies.

Live Support Efforts are concluded within 30 days allowing the inventory to move forward in the appropriate revenue cycle protocols.

Service can be engage in varying models;

• Bridging - temporary while you staff up or stabilize your staff.
• Slotted in - we slot in that critical time frame and out by 30 days.
• Customize - to fit to your circumstances .

Serving an under-served segment with a solution; "Live" Support".

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Helping people, changing lives: 3 health benefits of volunteering

The good news is that you don't need to be a philanthropist or senator to enhance or create change in your community. Volunteering makes an immeasurable difference in people's lives. Your actions, big or small, can help others and benefit your health.

Governance - Compliance

New healthcare poll shows most Texas voters want government regulation for healthcare mergers

Texas 2036 is a non-partisan public policy research and advocacy organization. They consider the state’s future as it turns 200 years old in a little over a decade. 1,001 Texans were polled by Texas 2036 in November. Seventy-five percent of those surveyed were in agreement that the state should more actively regulate healthcare mergers.

Louisiana physician charged for $6.6M fraud scheme

A physician in Slidell, La., has been charged in connection with an alleged $6.6 million fraud scheme.

Between February and September 2019, Robert Tassin, MD, allegedly signed physician orders for genetic cancer screening tests through purported telemedicine companies for Medicare beneficiaries he never saw, spoke to or treated, according to a March 12 news release from the Justice Department.

Healthcare billing fraud: 10 recent cases

Here are 10 healthcare billing fraud cases that Becker's has reported since Feb. 18: