Health Plan Payment and Reimbursement

How to meet your patients’ communication preferences and improve your bottom line

In this HFMA executive roundtable, seven health system leaders share their efforts to effectively engage patients and the lessons they have learned along the way.

HFMA January 30, 2023

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

Labor costs and other concerns dampen the outlook for not-for-profit hospitals this year

Insights from a leading credit-rating agency illustrate the scope of the financial challenges facing not-for-profit hospitals in 2023.

Nick Hut January 10, 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

Healthcare News of Note: More than 3,500 deaths in the US attributed to long COVID during a 30-month period

For a 30-month period beginning in January 2020, long COVID played a part in the deaths of 3,544 people, according to a report by the CDC’s National Center for Health Statistics. The Department of Justice has support from hospital advocates as it looks to appeal a court ruling that allowed UnitedHealth Group to acquire Change…

Deborah Filipek December 23, 2022

New federal rule aims to eventually ease prior authorization processes

CMS is seeking to improve the prior authorization process in government programs such as Medicare Advantage (MA) and Medicaid, although the core provisions would not begin until 2026. The agency this week updated a Trump administration proposed rule with new proposals to “improve patient and provider access to health information and streamline processes related to prior authorization…

Nick Hut December 9, 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

CareCredit healthcare credit card provides flexible payment options for both patients and healthcare providers

Read about one company's payment solution that gives patients a way to pay for out-of-pocket healthcare costs while enabling health care organizations to receive payment for services within two business days.

HFMA December 1, 2022

No Surprises Act regulations remain a moving target for compliance

Amid all the rules stemming from the No Surprises Act, a looming mandate for providers to send cost estimates to health plans looks like the biggest stress inducer.

Nick Hut October 18, 2022
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