Compliance

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.…

Nick Hut October 9, 2023

Money received through the Provider Relief Fund could be at risk as audits ramp up

Recipients of Provider Relief Fund (PRF) distributions and COVID-19 Uninsured Program payments should be girding themselves for audits, legal experts say. The programs represent “a two-front audit fight that providers are facing and will face in the coming years,” Brian Lee, partner with Alston & Bird, said during an Aug. 24 webinar hosted by the…

Nick Hut September 1, 2023

The evolution of telehealth and the potential for sustainability

The surge in use of telehealth services seen during the pandemic has slowed, but telehealth remains a key modality amid policy changes that will help set the course for the future of virtual care. “There’s no alternative,” said Kyle Zebley, senior vice president for public policy with the American Telemedicine Association (ATA) and executive director…

Elizabeth Barker August 30, 2023

Key questions for providers after more than 2 years of the price transparency rule

Evidence amassed from over two years of experience with compliance reinforces why providers need to focus on chargemaster prices and self-pay discount policies — and how they can benefit from analyzing trends in consumers’ price searches.

Fred Stodolak August 25, 2023

FTC and HHS’s Office for Civil Rights put healthcare stakeholders on notice about the use of tracking technology

Federal regulators plan to more rigorously monitor whether tracking technologies on provider websites are impermissibly disclosing consumers’ protected health information (PHI) to third parties in violation of HIPAA. The Federal Trade Commission (FTC) and the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services last month sent a letter to…

Nick Hut August 10, 2023

In proposed regulations, CMS seeks to strengthen hospital price transparency requirements

Hospital price transparency regulations are undergoing changes heading into their fourth year as CMS seeks to step up enforcement while making compliance more straightforward. As part of the 2024 proposed rule for hospital outpatient payments, CMS is adding to the requirement for hospitals to maintain a machine-readable file of their charges for services. In addition,…

Nick Hut July 17, 2023

News Briefs: The expiration of the COVID-19 PHE brings an end to key provisions

The termination of the COVID-19 public health emergency (PHE) on May 11 meant providers lost many of the accommodations and regulatory flexibilities that were in place since Jan. 31, 2020. For example, Medicare’s 20% add-on payment for treating COVID-19 cases in the inpatient setting no longer is available. With reported cases and hospitalizations steadily trending…

Nick Hut May 30, 2023

Healthcare providers seeing more diagnosis-related group downgrades and ghost denials

Each year, tens of millions of medical claims will be denied by healthcare payers. One executive director led a session with more than a dozen attendees highlighting their experiences with DRG downgrades and lessons learned to help other organizations better measure, manage and successfully appeal these complex denials.

HFMA May 30, 2023

Hospital price transparency updates include stricter enforcement, new fines and pending legislation

(Note: The last section of this article was updated May 24 where noted to reflect developments in Congress.) Enforcement of hospital price transparency regulations is becoming stricter, with CMS implementing new policies and recently fining two hospitals. Changes were anticipated after CMS leaders authored an article in February that reported 70% compliance in 2022, the…

Nick Hut May 17, 2023

New data on No Surprises Act arbitration cases show providers are faring well amid systemic challenges

Providers are having success at challenging out-of-network payment amounts under the No Surprises Act, at least when they can get their cases through the arbitration system. CMS published an update showing that between April 15, 2022, when the independent dispute resolution (IDR) portal opened, and March 31, arbitrators issued payment determinations in 42,158 disputes. Initiating…

Nick Hut May 2, 2023
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