Payment Reimbursement and Managed Care

Texas court again backs providers in No Surprises Act independent dispute resolution litigation

A physician association continues to roil the No Surprises Act’s arbitration process through successful litigation. The Texas Medical Association (TMA) this week prevailed in court for the second time in a year after arguing that regulations governing the independent dispute resolution (IDR) process do not comply with legislative intent. Barring a successful appeal, the U.S.…

Nick Hut February 8, 2023

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

How to meet your patients’ communication preferences and improve your bottom line

In this HFMA executive roundtable, seven health system leaders share their efforts to effectively engage patients and the lessons they have learned along the way.

HFMA January 30, 2023

How Braven Health is looking to improve the lives of New Jersey patients through value-based care

Patrick Young, president of population health for Hackensack Meridian Health and Jeff Smith, chief commercial officer at value-based managed services operator Lumeris, share the success story of payer-provider partnership Braven Health.

Erika Grotto January 30, 2023

Healthcare News of Note: 100 hospitals receive funding for new physician residency slots to boost healthcare access

CMS distributed 200 Medicare-funded physician residency slots to 100 hospitals, aiming to bolster healthcare access in areas with a shortage of qualified professionals. Overall cancer mortality has dropped 33% since 1991, averting an estimated 3.8 million cancer deaths, according to the American Cancer Society’s latest report. Patients’ ratings of specialist care were markedly higher when…

Deborah Filipek January 30, 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

Hospitals have options for effectively managing complicated reimbursements

How can health systems and patients both win when it comes to payment? Read this article to learn how hospitals can maximize collections and get paid for provided services on top of how patients can identify source of payment that is not out of pocket.

HFMA January 26, 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
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