Payment Reimbursement and Managed Care

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

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

Limit financial risk from Medicaid redetermination

Medicaid redetermination isn’t going smoothly. As of late December 2023, the Kaiser Family Foundation found that 71% of Medicaid disenrollments nationwide were for procedural reasons. That means patients are losing coverage because they filled out a form incorrectly or missed a deadline, not because they’re truly ineligible for renewal. Provider organizations can play a pivotal…

Noel Felipe January 24, 2024

Recent updates and emerging best practices for ACOs in the Medicare Shared Savings Program

Going into the 12th year since it brought accountable care into the healthcare lexicon, the Medicare Shared Savings Program (MSSP) continues to evolve, with CMS making changes and participants fine-tuning best practices. Starting with 220 accountable care organizations (ACOs) in 2012-13, the MSSP grew to 561 in 2018. However, the number has been below 500…

Nick Hut January 9, 2024

Empowering patient access teams: The transformative impact of training and development

Hospital patient access teams are often the first encounter a patient has with the hospital. The patient access encounter sets the stage for the entire patient experience and has financial implications as well. Effective registration, eligibility verification, coverage discovery and collection workflows are required for optimal revenue cycle outcomes. Training and development have a big…

HFMA January 8, 2024

3 key interventions to address lagging payer reimbursements

It seems as if  commercial payers are doing all they can to keep from reimbursing providers in a timely manner. According to a recent report by Crowe, 31% of claims submitted to commercial payers in the first quarter of 2023 were not paid for at least three months, as compared with 12% of Medicare claims.…

HFMA October 9, 2023

Medicaid DSH payment cut barely averted as House, Senate pass short-term federal funding

Hospitals received a last-day reprieve from substantial cuts to Medicaid disproportionate share hospital (DSH) payments, with House leaders reversing course Sept. 30 and ushering through a six-week government funding package. Language in the bill ensures a four-year, $32 billion Medicaid DSH cut will not take effect before Nov. 17. Most importantly, the bill bought time…

Nick Hut October 4, 2023

Update: Medicaid DSH payment cut averted as House, Senate pass short-term federal funding

Note: The headline and lead section of this article were updated Oct. 1 with news of a six-week government funding extension that delays the Medicaid DSH cuts and pays for other healthcare programs. The article originally was published Sept. 28 under the headline, “An $8 billion Medicaid DSH cut is closer to happening as a…

Nick Hut October 1, 2023

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…

Nick Hut September 19, 2023
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