Cyberattack on Change Healthcare brings turmoil to healthcare operations nationwide
Highlights April 9: A possible second ransom demand March 28: Issues with transmitting files to and from payers March 26: A list of payer contacts for providers to inquire about advance payments March 22: An update on the restoration of claims submission March 14: An FAQ on Medicare accelerated and advance payments March 6: Recommendations…
New data shows providers continuing to win most No Surprises Act independent dispute resolution cases
Providers won a large majority of disputes initiated during the first half of 2023 through the No Surprises Act’s arbitration portal for adjudicating out-of-network payments, according to newly published data. HHS and the U.S. Departments of Labor and Treasury released public-use files (available to download here under “2023 Reporting Year”) showing the outcome of every…
Medicare beneficiaries would have new options for appealing their hospital patient status under a proposed rule from CMS
A proposed rule from CMS would affect the appeals process for some patients whose status is reclassified from inpatient to outpatient observation during a hospital stay. After a 2020 court ruling that was upheld at the appellate level in 2022, the U.S. Department of Health and Human Services and CMS were obligated to create additional…
HHS: Insurers won’t be penalized if they don’t update their No Surprises Act qualifying payment amounts as required
Providers may not immediately benefit from a favorable court ruling that affects the methodology for determining the qualifying payment amount (QPA) under the No Surprises Act. The U.S. Department of Health and Human Services (HHS) issued guidance Oct. 6 that says the Biden administration will not enforce the court decision until at least May 1.…
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…
No Surprises Act litigation update: QPA methodology deemed illegal as Texas Medical Association wins in court again (updated)
Note: The first section of this article has been updated with the latest news on the status of the arbitration portal. The fourth victory in four cases brought by the Texas Medical Association (TMA) has implications for how insurers calculate the qualifying payment amount (QPA) used to arbitrate out-of-network payment sums under the No Surprises…
Healthcare News of Note: DOL sues UnitedHealth Group subsidiary for claim denials
The U.S. Department of Labor recently sued UMR Inc., the nation’s largest third-party healthcare claims administrator, for denials involving emergency department services and urinary drug screening. Twenty-two of U.S. News & World Report’s Best Hospitals also made the publication’s honor roll, which recognizes hospitals for demonstrating exceptional breadth of excellence across clinical specialties. Substantial resources…
House committee approves bill requiring national provider identifiers for off-campus outpatient departments
A bill with widespread support in Congress would affect hospital billing procedures at off-campus outpatient departments if it becomes law. The House Committee on Education and the Workforce on July 12 unanimously approved legislation called the Transparency in Billing Act, which states that starting in 2024, hospital claims for items and services furnished in off-campus…
Report quantifies the financial impact of certain health plan business practices on providers
As hospitals seek to regain their financial footing coming out of the pandemic, they may find themselves stymied by commercial payer policies, according to a new report. “It’s true that commercial payers might generate more net revenue than public payers on a per-case basis,” Crowe states in a report it recently published. “But at what…
How healthcare organizations navigate claims processing
View the results of a survey about claims processing and revenue cycle performance conducted with more than 625 healthcare leaders.