Payment Reimbursement and Managed Care

Healthcare Finance Trends for 2024

Download this eBook to see details of the 10 financial trends that will shape 2024 for hospitals and health systems across the country.

HFMA February 28, 2024

Healthcare Blame Game: Bloomberg Philanthropies puts $250 million into educating new healthcare workers while Patient Rights Advocate spends on spreading misinformation

Chad Mulvany, vice president of federal policy for the California Hospital Association and former HFMA policy director, discusses Bloomberg Philanthropies $250 million investment in the future healthcare workforce, as well as what will actually move the needle on price transparency.

Erika Grotto February 26, 2024

Cyberattack on Change Healthcare brings turmoil to healthcare operations nationwide

Feb. 28 updates The FBI, the Cybersecurity and Infrastructure Security Agency (CISA) and HHS issued a joint advisory regarding the ransomware gang that is said to have perpetrated the cyberattack on Change Healthcare. The implication behind the alert is that the group is not done targeting the healthcare sector. Of nearly 70 organizations that are…

Nick Hut February 25, 2024

New rule on Medicaid DSH payments will impose stricter limits on many hospitals

Numerous hospitals that receive Medicaid disproportionate share hospital (DSH) payments face a tighter cap on their payment amounts after the Feb. 23 publication of a CMS final rule. The regulations were spawned by 2020 year-end legislation that made changes to the DSH hospital-specific limit (HSL), including with respect to how third-party payments factor into the…

Nick Hut February 23, 2024

New data shows providers continuing to win most No Surprises Act independent dispute resolution cases

Providers won a large majority of disputes initiated during the first half of 2023 through the No Surprises Act’s arbitration portal for adjudicating out-of-network payments, according to newly published data. HHS and the U.S. Departments of Labor and Treasury released public-use files (available to download here under “2023 Reporting Year”) showing the outcome of every…

Nick Hut February 21, 2024

Site-neutral payment has backing in healthcare policy circles, but its efficacy as a cost restraint is unclear

The concept of site-neutral payment continues to receive support from members of Congress and healthcare policy analysts, as demonstrated during a recent hearing. The Jan. 31 hearing of the House Energy and Commerce Committee’s Health Subcommittee was intended, in part, to promote pending legislation that would strengthen price transparency and implement other policies designed to…

Nick Hut February 15, 2024

CMS’s 2025 advance rate notice for Medicare Advantage brings potential concern for providers

Medicare Advantage (MA) health plans are projected to reap a 3.7% revenue increase in 2025, but provider payments could be affected by a decrease in plan benchmarks, per data shared in CMS’s annual advance notice. If finalized, the estimated 0.16% average reduction in base payments to plans could have consequences for care delivery, one provider…

Nick Hut February 7, 2024

Hospitals say Supreme Court should hear a case that affects disproportionate share hospital payments

Hospital advocacy groups hope the Supreme Court will review a lower-court ruling that has adverse implications for Medicare disproportionate share hospital (DSH) payments. Six groups on Feb. 2 submitted an amicus brief to the Supreme Court regarding an appeals court’s 2023 decision backing HHS’s interpretation of the DSH payment formula. The department long has said…

Nick Hut February 5, 2024

Healthcare Blame Game: Patient Rights Advocate’s distortion of price transparency regulations and data, and the ad campaign that’s catching attention

Patient Rights Advocate (PRA) has engaged hip hop artists like Fat Joe, Busta Rhymes and Method Man in its “Power to the Patients” campaign, claiming that regulations around price transparency are not being enforced, allowing hospitals to hide their prices and “charge whatever they want.” On this episode, HFMA Policy Director Shawn Stack and Ruth Lande, vice president of hospital relations at RIP Medical Debt, discuss PRA’s misinterpretation of price transparency regulations and hospital pricing.

Erika Grotto February 5, 2024

Continued 340B eligibility is at risk for hundreds of hospitals thanks to pandemic-related factors

Hospitals that rely on savings from the 340B Drug Pricing Program should examine the possibility that they’ll soon be rendered ineligible. Several factors are having an industrywide impact on the disproportionate share hospital (DSH) adjustment percentage, and if that tally drops below a certain threshold on a hospital’s Medicare cost report, the hospital cannot receive…

Nick Hut February 2, 2024
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