As anticipated, the start of the Medicaid unwinding process has taken a toll on coverage
Fears among healthcare policymakers that the end of the COVID-19 public health emergency would sow chaos in Medicaid have been realized, leading the Biden administration to intensify its mitigation efforts. The end of Medicaid continuous-enrollment provisions is affecting the program in many states. In 21 states that had begun the “unwinding” process since April 1,…
Medicare coverage and coding updates: New Alzheimer’s drugs to be covered, but not universally
Note: This article was updated July 6. For drugs manufactured to slow the progression of Alzheimer’s disease, Medicare will offer coverage with certain qualifications, according to a recent CMS announcement. The new policy especially is relevant because the FDA’s first full approval of an Alzheimer’s disease drug may be only a month or so away.…
Report quantifies the financial impact of certain health plan business practices on providers
As hospitals seek to regain their financial footing coming out of the pandemic, they may find themselves stymied by commercial payer policies, according to a new report. “It’s true that commercial payers might generate more net revenue than public payers on a per-case basis,” Crowe states in a report it recently published. “But at what…
Inside HFMA: 100,000th member reflects on value of HFMA enterprise membership
For LaTasha Bowen, membership in HFMA is synonymous with opportunity — but it’s an opportunity she might not have received without the Association’s enterprise membership program. Bowen is revenue cycle manager for Hughston Clinic, a Columbus, Georgia, medical group specializing in musculoskeletal disorders. While the clinic had been part of HFMA’s MAP Keys program for…
Ann Jordan named HFMA’s new president and CEO
Ann Jordan, JD, begins her tenure as HFMA’s new president and CEO on June 6, becoming the first female executive at the Association’s helm during its 77-year history. “This is an incredibly dynamic time for healthcare finance professionals,” said Jordan in an April 5 news release. “I am honored for the opportunity to join HFMA…
The state of Medicare Advantage: As the program grows, healthcare stakeholders express concerns
As seen during a recent virtual conference, the accelerating expansion of Medicare Advantage (MA) has been accompanied by tension over growing pains such as regulatory issues. “I think MA was set up really well, but like anything else there’s sort of a moment where you have to look at the program and say: How do…
CMS issues RFI to gather best practices for identifying and supporting safety net hospitals
As part of the FY24 proposed rule for hospital inpatient payments, CMS is seeking healthcare stakeholder input on how to best support safety net hospitals in the Medicare program. The agency is considering ways to reimburse safety net hospitals via supplemental payments that may be better targeted than disproportionate share hospital (DSH) and uncompensated care…
Hospital price transparency updates include stricter enforcement, new fines and pending legislation
(Note: The last section of this article was updated May 24 where noted to reflect developments in Congress.) Enforcement of hospital price transparency regulations is becoming stricter, with CMS implementing new policies and recently fining two hospitals. Changes were anticipated after CMS leaders authored an article in February that reported 70% compliance in 2022, the…
Congress seems inclined to expand site-neutral payment policies in Medicare (updated)
Momentum is building in Congress toward expanding site-neutral payment in Medicare, a move that could reduce payments to hospitals by billions of dollars per year. A recent hearing, which lasted 5 ½ hours, focused on various ideas for promoting transparency and competition in healthcare. The hearing included references to 17 bills or discussion drafts, several…
The COVID-19 public health emergency is over: Here’s what healthcare providers should know
An era ends for the U.S. healthcare industry with the termination of the COVID-19 public health emergency (PHE) at the close of the day on Thursday, May 11. The termination means providers are losing many of the federal waivers and flexibilities that have been in place for all or most of the PHE, which took…