CMS pressures states to restore Medicaid coverage for some beneficiaries who have been disenrolled
CMS says a recent edict to state Medicaid programs has partially stanched the ongoing wave of disenrollments in the program, with about 500,000 beneficiaries set to regain coverage they had lost and “many” others protected from disenrollment going forward. As described in a Sept. 21 summary, 29 states plus Washington, D.C., have acknowledged a systemic…
HHS sets new administrative fee to be paid by parties in No Surprises Act independent dispute resolution cases
Oct. 6 update: The lead section of this article was updated where noted with news about the arbitration portal. The administrative fee for taking out-of-network payment disputes to arbitration under the No Surprises Act in 2024 would be significantly lower than it was for much of 2023, but triple the current rate, according to proposed…
Healthcare News of Note: Providers in these 10 states may struggle the most to collect claims from payers
Over the past few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals. 1. The top and bottom states for paying provider claims are detailed in new report “A connection exists between where a provider operates and how fast and accurately claims are paid,” according to a…
American providers remain in reimbursement limbo during IDR failure
HFMA and its member healthcare providers are growing more concerned over the extended delay of reimbursement from group health plans subject to the unresolved No Surprises Act IDR regulations and guidance. HFMA members continue to report that numerous health plans persist in determining very low rates for calculating the Quality Performance Assessment (QPA) they are…
As clock ticks toward massive Medicaid disproportionate share hospital cuts, proposed bill would bring relief
A congressional bill that would impose additional transparency requirements on providers also would offer a respite from a sizable cut to a key supplemental payment. A $32 billion reduction to Medicaid disproportionate share hospital (DSH) payments is scheduled to span four years, beginning when federal FY24 gets underway Oct. 1. The Lower Costs, More Transparency…
Healthcare News of Note: Women without insurance or with public insurance at the time of childbirth are more likely to report mistreatment, says CDC
Over the past few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals. 1. More women without insurance and with public health insurance report mistreatment during maternity care than those with private insurance Maternity care in the United States was put under the microscope in a new…
Patient Rights Advocate continues to misinterpret price transparency data with latest report
Once again, Patient Rights Advocate (PRA) has issued a report that misrepresents compliance with CMS price transparency regulations. (Read my March blog about a previous PRA report here.) PRA’s most recent “Hospital Price Transparency Compliance Report,” published in July, examines websites of 2,000 U.S. hospitals. Its findings were that only 36% of those hospitals fully…
Legislation to enhance healthcare pricing and billing transparency takes a big step forward in the House
A slew of provisions on healthcare transparency took a step closer to becoming federal law as three House committees last week merged separate bills into a single draft. The resulting bill is just about set for consideration by the full House, where bipartisan support for the major provisions was apparent in the committee phase. The…
Healthcare News of Note: Unlocking new revenue streams is the healthcare industry’s top priority, while workforce issues are its top risk
Over the past few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals. 1. Introducing new revenue streams is the top priority for the healthcare sector, and talent acquisition/retention is its top risk, survey says More executives in healthcare (44%) selected “introducing new revenue streams” as their…
Published data quantify how cost increases will continue to affect the healthcare industry next year
The cost to treat patients will accelerate next year, with ramifications across the healthcare industry, according to newly published projections. PwC’s Health Research Institute reported that the cost of providing care will increase by 7% in 2024, up from a 6% increase this year and 5.5% in 2022. A 7% increase would tie 2021 for…