Author: Nick Hut

In new final rule, CMS looks to claw back billions in overpayments to Medicare Advantage health plans

CMS has confirmed a new approach to its auditing of payments directed to Medicare Advantage health plans, but the agency says the regulatory burden on providers should not increase. A newly published final rule on risk adjustment data validation (RADV) establishes that CMS will use an extrapolation methodology to recoup overpayments to MA plans beginning…

Nick Hut February 3, 2023

OIG describes how hospitals can use NPs to treat patients without violating the Anti-Kickback Statute

An advisory opinion from the HHS Office of Inspector General (OIG) appears to give hospitals leeway to expand their use of nurse practitioners in specific situations without violating the Anti-Kickback Statute. OIG issued the opinion in December in response to an inquiry from an unnamed acute care hospital. The hospital was seeking clarification on whether…

Nick Hut February 1, 2023

How healthcare providers can break down barriers to effective data governance

Promoting improved data governance in the hospital and health system sector has become a just cause of sorts for Randy Albert, who serves as vice president of finance – operations and analytics at Maine-based Northern Light Health and is a member of HFMA’s Northern New England Chapter. “This is a topic that I’m incredibly passionate…

Nick Hut January 27, 2023

News Briefs: 2023 brings a steep fee hike for No Surprises Act arbitration cases

The No Surprises Act’s independent dispute resolution (IDR) process has become more expensive for healthcare stakeholders. For the new year, the nonrefundable administrative fee due from each party involved in any payment dispute that goes to arbitration increased from $50 to $350, according to a Dec. 23 memo from CMS’s Center for Consumer Information and…

Nick Hut January 27, 2023

CVS Health pushes forward with efforts to reshape segments of the healthcare industry

About two decades after adding the first three MinuteClinics to its stores, in 2005, CVS Health continues to grow as one of the biggest disruptors in healthcare. The company has embarked on a series of strategic transactions that make it a major player across an increasingly large swath of the industry, as described this month…

Nick Hut January 27, 2023

During a potentially tumultuous Congress, healthcare stakeholders should communicate their policy priorities

With the 118th Congress bringing the potential for policy upheaval, one of the best things healthcare stakeholders can do is make themselves heard on Capitol Hill. The new Republican majority in the House of Representatives has signaled its intent to use the federal debt ceiling as leverage in budget negotiations. President Joe Biden and the…

Nick Hut January 24, 2023

Key points to know in recently proposed rules for Medicare Advantage and the ACA marketplaces

A proposed rule for health plans in Medicare Advantage has provisions designed to stem overreach in prior authorization processes.

Nick Hut January 20, 2023

Seeking to phase out Medicare DSH payments, MedPAC outlines potential changes to reimbursement for safety net providers

Revamped formulas for hospitals and physicians would be designed to better target payments to providers that treat larger shares of low-income Medicare beneficiaries.

Nick Hut January 18, 2023

Remedies for 340B underpayments remain up in the air after court declines to provide guidance

A federal court is allowing HHS to decide on remedies covering Medicare underpayments to hospitals for 340B drugs.

Nick Hut January 11, 2023

Labor costs and other concerns dampen the outlook for not-for-profit hospitals this year

Insights from a leading credit-rating agency illustrate the scope of the financial challenges facing not-for-profit hospitals in 2023.

Nick Hut January 10, 2023
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