HFMA recognizes 2,075 members who earned certifications in Q3 2024
HFMA now offers 11 certifications for members to validate their expertise and demonstrate their commitment to the profession, including the two recently launched certifications highlighted in bold in the list below. The HFMA certifications are as follows: Multiple certification holders Of the 2,075 people earning certifications in Q3, 101 attained more than one HFMA certification.…
What the site-of-care shift for joint replacement means for hospitals
Hospital patient volumes mostly have been on an upswing since the worst of the COVID-19 pandemic, but certain trends represent cautionary tales for long-term finances. For example, the latest report (registration required) from Strata Decision Technology shows a year-over-year decline in August of more than 21% for inpatient primary knee replacement procedures. A shift to…
HFMA now offers AI Governance Micro-Credential for healthcare finance professionals
As HFMA prepared to introduce its first micro-credential for healthcare finance professionals, we sat down with Todd Nelson, HFMA’s director of professional practice and partner relationships, to learn more. Q: HFMA just came out with its first micro-credential. Can you tell us more about it? Todd Nelson: HFMA launched its first micro-credential training course Nov.…
Medicare’s 2025 payment updates: Why hospitals and physicians think the methodologies are flawed
Neither hospitals nor physicians found much reason for encouragement in final 2025 Medicare payment rules released Nov. 1. The rules, which were made available as pre-publication drafts, finalized a 2.9% increase for hospitals under the payment system for Medicare outpatient services and ambulatory surgical centers (ASCs). Meanwhile, physicians were dealt a 2.83% cut that they…
Senate leaders release a blueprint for comprehensive site-neutral payment policies
To the disappointment of hospital groups, two Senate leaders have produced bipartisan policy options for advancing site-neutral payment in Medicare. The framework released Nov. 1 by Sens. Bill Cassidy (R-La.), who is a physician, and Maggie Hassan (D-N.H.) goes further than site-neutral payment plans that were passed by the House as part of broader healthcare…
Providers’ winning streak in No Surprises Act QPA litigation ends as appeals court overturns a prior ruling
Healthcare providers incurred a rare defeat in litigation over a key facet of the No Surprises Act, with an appeals court ruling that the original methodology for calculating the qualifying payment amount (QPA) is permissible. The Oct. 30 decision restores language from prior regulations and means insurers can continue to incorporate or exclude certain disputed…
HFMA provides a comprehensive, curated list of CMS guidance on the 2-midnight rule/benchmark for use by payers and providers
Health systems nationwide continue to report unjust increases in beneficiary cost-sharing and delays in post-acute care by Medicare Advantage (MA) plans. These delays often result from automatic downgrades that contradict CMS requirements, specifically those relating to the agency’s two-midnight rule/benchmark, which mandates adherence by MA plans to establish agency-directed care standards. Despite the mandate that…
Report suggests the extent to which Medicare Advantage health plans are skirting the two-midnight rule
As hospitals struggle with payer tactics involving denials, a new analysis quantifies the extent to which Medicare Advantage (MA) health plans still avoid paying for inpatient care. The report by Kodiak Solutions examined claims data from more than 1,900 hospitals and found that MA plans categorized hospital visits as outpatient observation stays at a rate…
Providers can expect UnitedHealthcare to undertake closer inspection of coding patterns
Healthcare spending that exceeded expectations is motivating UnitedHealthcare to take a more rigorous look at provider coding practices. For two consecutive quarters, parent company UnitedHealth Group (UHG) has reported that the medical-cost ratio (MCR) of UnitedHealthcare is being impacted by several factors. One is provider coding trends, the company’s leaders said during investor calls. “In…
Finalized appeals processes for Medicare patients will require new hospital protocols in 2025 (updated)
Hospitals should prepare to imminently accommodate new appeals processes and paperwork for some Medicare patients whose status gets changed from inpatient to outpatient observation during a stay. A newly published final rule gives beneficiaries options for appealing such a change. The effective date of the new appeals processes was not announced in the rule, but…