Payment Reimbursement and Managed Care

Survey data highlights shortcomings in private insurance coverage compared with Medicare

Indicators of coverage gaps were more likely to be seen among individuals with private insurance.

By Nick Hut June 2, 2021

New CMS Administrator Chiquita Brooks-LaSure gets ready to tackle surprise billing, rural healthcare and much more

During her Senate confirmation hearing, Brooks-LaSure said strengthening Medicare, Medicaid and the Affordable Care Act to bolster quality and access while lowering costs will be paramount.

By Nick Hut May 28, 2021

Democratic congressional leaders ramp up efforts to craft a health insurance public option, generating hospital pushback

Leading Democrats in the House and Senate sent out a request for information to healthcare stakeholders, seeking input as they look to establish a public option for health insurance.

By Nick Hut May 26, 2021

CMS is curtailing voluntary participation in the Comprehensive Care for Joint Replacement bundled payment model

Hospitals that participated in the Comprehensive Care for Joint Replacement model on a voluntary basis over the last three years will be excluded after Sept. 30.

By Nick Hut May 3, 2021

In a win for hospitals, CMS removes a rate-reporting requirement from the Medicare FY22 Inpatient Prospective Payment System

An FY22 requirement for hospitals to disclose privately negotiated MA rates on their Medicare cost reports has been rescinded in the proposed rule for the Inpatient Prospective Payment System.

By Nick Hut April 29, 2021

Key payment details in the Medicare FY22 Inpatient Prospective Payment System proposed rule

CMS’s FY22 proposed rule for the Inpatient Prospective Payment System includes a 2.8% payment increase for general acute care hospitals.

By Nick Hut April 28, 2021

Update on Medicare payment policy for treatments involving bamlanivimab

Medicare no longer will pay healthcare providers for administering the COVID-19 treatment bamlanivimab now that the FDA has revoked the Emergency Use Authorization for treatments in which the drug is administered alone.

By Nick Hut April 20, 2021

CMMI announces Direct Contracting participants but cancels second round of applications

The Center for Medicare & Medicaid Innovation announced the 53 entities that have been accepted as participants in the new Global and Professional Direct Contracting model.

By Nick Hut April 9, 2021

HHS delays implementation of rule requiring FQHCs to provide insulin, epinephrine at 340B prices

HHS has postponed a Trump administration regulation that would require federally qualified health centers to make certain drugs more affordable for low-income patients and will consider whether to withdraw the rule altogether.

By Nick Hut March 24, 2021

Disproportionate Share Hospital funding to states doesn’t match up with key benchmarks, report finds

Disproportionate Share Hospital payments don’t always align with key metrics such as uninsured rates and uncompensated care costs, a new policy report finds.

By Nick Hut March 17, 2021
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