Hospitals not yet a fraud focus
The Trump administration has ramped up high-profile healthcare fraud prevention efforts across a range of areas. Hospitals are not yet in the crosshairs. Ryan Thurber, an attorney with Polsinelli, said the focus of much of the administration’s healthcare and Medicaid fraud detection is on “nontraditional providers” of services around the periphery of healthcare, such as…
Operational resilience is the revenue cycle management imperative of the OBBBA era
The One Big Beautiful Bill Act (OBBBA) has altered Medicaid eligibility in ways hospitals can no longer treat as a background policy issue. Reverification of Medicaid coverage now happens so frequently that patients lose coverage for administrative reasons that have nothing to do with whether they actually qualify. Much of the industry dialogue has centered…
Navigating regulatory challenges in hospital revenue cycle: the impact on RCM teams and the path forward
The term “regulatory compliance” is often associated with its cost. However, the foundational purpose of regulations is to protect patients and ensure quality care. Most would agree a healthcare system without regulations would be catastrophic. But provider organizations are now burdened with managing compliance under increasingly complex requirements. If they fall short, they can expect…
Legal and Regulatory Compliance
HHS should ensure 340B hospitals remain eligible despite changes in payer mix, AHA says
Hospitals participating in the 340B Drug Pricing Program could lose access due to payer mix changes stemming from the COVID-19 pandemic unless HHS issues a waiver.
Providers should prepare for a possible expansion of Medicare site-neutral policies
HFMA’s Chad Mulvany says if the CY2021 OPPS rule is finalized as proposed without significant modifications to CMS's MS-DRG weight-setting process, it heightens the need for hospitals to expand outpatient/ASC capacity and continue aggressive cost management.
And the small print taketh away: Providers need to stay updated on HHS changes to the CARES Act Provider Relief Fund terms and conditions
HFMA's Chad Mulvany reviews some of the U.S. Department of Health & Human Service's changes to the terms and conditions related to the CARES Act Provider Relief Fund.
5 ways to drive patient privacy law compliance from within your organization
While it makes sense to protect patients’ health-specific data, social security numbers and home addresses from external threats, the most significant threats to patient privacy laws are on the inside.
Addressing unclaimed property challenges
Healthcare providers increasingly are being audited for unclaimed property.
6 Steps to Effective Document Retention and Destruction
Implementing a document retention/destruction process avoids unnecessary storage fees and potential legal issues.