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.
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…
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…
Simon’s ensures the highest recovery rates and adheres to strict compliance standards
Find out how this debt collection services provider ensures its clients are updated on changes in state and federal compliance and law, while also leveraging digital components and maintaining the latest technology.
5 issues that are keeping healthcare compliance professionals up at night
Rarely has the compliance landscape been more muddled or presented more of a challenge for healthcare organizations. “I’ve been a compliance officer for about 20 years now, and I’ve been in healthcare forever,” said Kirsten Wild, RN, a nurse by background who now owns a healthcare compliance consultancy. “But the volume and the pace of…
Hospital price transparency update: Regulatory enforcement soon could become stricter, CMS leaders say
Although nothing is official, CMS leaders indicate enforcement of hospital price transparency regulations is set to become more stringent. For an article published in Health Affairs, the Center for Medicare’s Meena Seshamani, MD, PhD, director, and Douglas Jacobs, MD, chief transformation officer, touted progress that has been made since the rules took effect Jan. 1,…
DOJ withdraws guidance that bolstered antitrust safe harbors for GPOs, cost benchmarking and more
Potentially leading to stricter enforcement of antitrust policy in healthcare, the U.S. Department of Justice has withdrawn guidance that essentially promoted certain arrangements in the industry. The Feb. 3 announcement from DOJ’s Antitrust Division amounts to a cancellation of so-called “safety zones” that were established in three sets of nonbinding guidance issued between 1993 and…
Honor Roll: HFMA awards certifications to 2,746 members between September and December 2022
HFMA offers eight certifications for members to validate their expertise and demonstrate their commitment to the profession. The HFMA certifications are as follows: Certified Healthcare Financial Professional (CHFP), Certified Revenue Cycle Representative (CRCR), Certified Revenue Cycle Representative (CRCR) – GCC, Certified Specialist Accounting & Finance (CSAF), Certified Specialist Business Intelligence (CSBI), Certified Specialist Physician Practice…
OIG describes how hospitals can use NPs to treat patients without violating the Anti-Kickback Statute
An advisory opinion from the HHS Office of Inspector General (OIG) appears to give hospitals leeway to expand their use of nurse practitioners in specific situations without violating the Anti-Kickback Statute. OIG issued the opinion in December in response to an inquiry from an unnamed acute care hospital. The hospital was seeking clarification on whether…
During a potentially tumultuous Congress, healthcare stakeholders should communicate their policy priorities
With the 118th Congress bringing the potential for policy upheaval, one of the best things healthcare stakeholders can do is make themselves heard on Capitol Hill. The new Republican majority in the House of Representatives has signaled its intent to use the federal debt ceiling as leverage in budget negotiations. President Joe Biden and the…