Payment Reimbursement and Managed Care

Medicare Drug Price Negotiation Program Guidance

HFMA presents a summary of CMS proposed initial guidance memorandum pertaining to the Medicare Drug Price Negotiation Program.

HFMA March 27, 2023

Healthcare News of Note: Medicare to negotiate reduced prices for 40 drugs by 2028, says study

Medicare drug price negotiation has the potential to benefit Medicare beneficiaries across some of the most common disease states.

Deborah Filipek March 23, 2023

Hospitals push back against a coordinated effort to revamp the 340B program

A lobbying fight has started over the future of the 340B Drug Pricing Program, with hospitals seeking to protect what they view as an essential source of cost savings. The advocacy group 340B Health and prominent hospital associations are seeking to repel an effort led by the Pharmaceutical Research and Manufacturers of America (PhRMA) to…

Nick Hut March 23, 2023

Highlights of the Administration’s FY 2024 Budget

HFMA presents a summary of healthcare-related proposals included in the President’s budget for fiscal year 2024, released by the Biden Administration on March 9, 2023.

HFMA March 21, 2023

New guidance for No Surprises Act arbitration looks like an improvement for providers

Responding to a recent court ruling, the U.S. Department of Health and Human Services (HHS) has updated the application of criteria for deciding No Surprises Act (NSA) independent dispute resolution (IDR) cases. Certified IDR entities (i.e., arbitrators) received guidance March 17 instructing them to more directly consider multiple factors when deciding on an out-of-network payment…

Nick Hut March 20, 2023

Here comes the Medicaid unwinding: The healthcare industry braces for coverage disruptions

A potentially tumultuous period for revenue cycle teams in particular and the U.S. healthcare system in general begins April 1, with the phasing out of a three-year run of Medicaid continuous enrollment. The so-called Medicaid “unwinding” originally was connected to end of the COVID-19 public health emergency (PHE), which is scheduled for May 11. But…

Nick Hut March 15, 2023

The media blame game regarding patient financial conversations

Brad Dennison, HFMA chief content executive, discusses the March hfm cover story about patient-friendly payment and what some media organizations get wrong.

Erika Grotto March 13, 2023

Data capture and coding for social determinants of health are works in progress, per reports

In the effort to bring social determinants of health (SDoH) more under the purview of healthcare providers, one tricky aspect is establishing a data and coding infrastructure. Recent reports highlight this challenge. For example, a survey conducted for the American Health Information Management Association (AHIMA) found that although 78% of 2,637 respondents said their organizations…

Nick Hut March 10, 2023

Medicaid DSH Third-Party Payer Proposed Rule Summary

HFMA presents a detailed summary of the proposed rule that would address legislative changes to the hospital-specific limit on Medicaid DSH payments as a result of the Consolidated Appropriations Act, 2021.

HFMA March 9, 2023

Medicare DSH Adjustment and Section 1115 Waiver Days Proposed Rule Summary

HFMA presents a detailed summary of the proposed rule published by CMS that would change the policies on how the Medicare disproportionate share adjustment is determined, relating to the counting of days associated with individuals eligible for certain benefits provided by section 1115 demonstrations.

HFMA March 9, 2023
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