Tag: Payment Reimbursement and Managed Care

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

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

Seeking to phase out Medicare DSH payments, MedPAC outlines potential changes to reimbursement for safety net providers

Revamped formulas for hospitals and physicians would be designed to better target payments to providers that treat larger shares of low-income Medicare beneficiaries.

Nick Hut January 18, 2023

Remedies for 340B underpayments remain up in the air after court declines to provide guidance

A federal court is allowing HHS to decide on remedies covering Medicare underpayments to hospitals for 340B drugs.

Nick Hut January 11, 2023

For the No Surprises Act arbitration process, 2023 brings a steep fee hike and continuing litigation

The No Surprises Act’s independent dispute resolution (IDR) process is about to become more expensive for healthcare stakeholders. In 2023, the nonrefundable administrative fee due from each party involved in any payment dispute that goes to arbitration will increase from $50 to $350, according to a Dec. 23 memo from CMS’s Center for Consumer Information and Insurance…

Nick Hut December 30, 2022

Massive federal spending bill alleviates reimbursement concerns for hospitals, but less so for physicians

Healthcare provider advocates applauded the inclusion of key reimbursement relief measures and other policies in a proposed federal spending bill for FY23, although physician groups expressed concern about the outlook for their constituents. With a divided Congress looking to muster the votes to pass the legislation before a self-imposed deadline of week’s end, the bill includes many…

Nick Hut December 20, 2022

HHS says the co-provider requirement for good-faith estimates is being tabled indefinitely

The U.S. Department of Health and Human Services has given hospitals and other healthcare providers a break on enforcement of a looming requirement for co-providers to be included on good-faith estimates (GFEs) furnished to uninsured patients.  HHS announced in an updated FAQ that it will continue to exercise “enforcement discretion” instead of potentially penalizing providers starting Jan.…

Nick Hut December 5, 2022

Final regulations for rural emergency hospitals set the stage for first year of eligibility

REHs will be reimbursed for providing emergency care and outpatient services and must abide by terms and conditions that include limiting average length of stay to 24 hours.

Nick Hut November 18, 2022

Changes to reimbursement for 340B drugs reverberate in the 2023 final rule for Medicare outpatient payments

The Medicare payment rate for hospital outpatient services will increase significantly in 2023, but the net gain will be quite a bit less than is apparent at first glance.

Nick Hut November 2, 2022

What healthcare system leaders say about the value-based care journey

In this roundtable, executives for health plans and health systems share challenges in value-based care and the significance of moving away from fee-for-service toward value-based-care.

HFMA June 29, 2022
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