Data indicate hospital operational logjams haven’t ceased after the public health emergency (updated)
Note: The fourth section of this article has been updated with news of proposed mandatory staffing ratios for long-term care facilities. Some of the problems that strained hospital operations during the peak of the COVID-19 pandemic have eased, but not enough to mark a true industrywide recovery, a recently released report suggests. Notably, the process…
Congress puts the community benefit standard for nonprofit hospitals under the microscope
The criteria that establish hospitals’ tax-exempt status are coming under closer scrutiny, with a bipartisan quartet of senators asking the IRS to ramp up its oversight of compliance with the community benefit standard. Sens. Bill Cassidy, MD (R-La.), Charles Grassley (R-Iowa), Raphael Warnock (D-Ga.) and Elizabeth Warren (D-Mass.) sent an Aug. 7 letter to the…
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…
Cyberattack leaves hospitals scrambling in several states
A recent attack was the latest to illustrate the potential of cybercriminals to cause havoc across an interstate health system. The Los Angeles-based Prospect Medical Holdings system incurred a ransomware attack Aug. 3 that temporarily required some patients to be diverted from emergency departments and relegated hospitals to using paper records and incorporating other downtime…
The No Surprises Act arbitration portal is temporarily closed for business after providers’ latest legal victory (updated)
Note: See the bottom of this article for the latest updates. The U.S. Departments of Health and Human Services (HHS), Labor and Treasury on Friday temporarily shut down the system for settling disputes over out-of-network payment amounts under the No Surprises Act. A day earlier, a federal judge gave the Texas Medical Association (TMA) the…
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,…
Medicare coverage and coding updates: New Alzheimer’s drugs to be covered, but not universally
Note: This article was updated July 6. For drugs manufactured to slow the progression of Alzheimer’s disease, Medicare will offer coverage with certain qualifications, according to a recent CMS announcement. The new policy especially is relevant because the FDA’s first full approval of an Alzheimer’s disease drug may be only a month or so away.…
Interoperability rule enforcement is coming. Are you ready?
Rita Bowen of MRO discusses why some organizations are choosing not to ready themselves for interoperability until enforcement begins and how reproductive care can throw a wrench into the process.
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…
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.