Healthcare Compliance

Articles covering healthcare regulations, legal issues, compliance requirements, risk management, and policy developments affecting healthcare organizations.

What the Change Healthcare cyberattack means for the future of the industry

In this episode, HFMA Senior Editor Nick Hut and Policy Director Shawn Stack discuss the latest developments on the Change Healthcare cyberattack, and Joshua Corman, founder of cybersecurity organization I Am the Cavalry, shares insights on what should come next in healthcare.

By Erika Grotto April 1, 2024

The FY24 HHS budget covers key programs for rural hospitals while tightening spending in some areas

The newly passed budget covering HHS during the remainder of FY24 contains notable provisions for healthcare providers. The roughly $117 billion departmental budget for the next six months was set in an appropriations bill that was passed by Congress and signed by President Joe Biden within hours of the March 22 expiration of funding for…

By Nick Hut March 25, 2024

Healthcare Blame Game: Patient Rights Advocate claims its report gets ‘independent review and validation’ – but does it?

Headline: The Sixth Annual Hospital Price Transparency Compliance ReportSource: Patient Rights AdvocatePublished: February 2024 PatientRightsAdvocate.org recently issued its sixth report scoring hospital compliance with federal price transparency regulations, and for the sixth time, its assessment conflicts with CMS’s assessment. I want to focus on a nugget we picked up on in the methodology section of the latest report,…

By Brad Dennison March 14, 2024

Site-neutral payment has backing in healthcare policy circles, but its efficacy as a cost restraint is unclear

The concept of site-neutral payment continues to receive support from members of Congress and healthcare policy analysts, as demonstrated during a recent hearing. The Jan. 31 hearing of the House Energy and Commerce Committee’s Health Subcommittee was intended, in part, to promote pending legislation that would strengthen price transparency and implement other policies designed to…

By Nick Hut February 15, 2024

Healthcare Blame Game: Patient Rights Advocate’s distortion of price transparency regulations and data, and the ad campaign that’s catching attention

Patient Rights Advocate (PRA) has engaged hip hop artists like Fat Joe, Busta Rhymes and Method Man in its “Power to the Patients” campaign, claiming that regulations around price transparency are not being enforced, allowing hospitals to hide their prices and “charge whatever they want.” On this episode, HFMA Policy Director Shawn Stack and Ruth Lande, vice president of hospital relations at RIP Medical Debt, discuss PRA’s misinterpretation of price transparency regulations and hospital pricing.

By Erika Grotto February 5, 2024

In Congress, it’s status quo for Medicaid DSH payments and the Medicare physician fee schedule

Yet another short-term federal funding measure from Congress included yet another brief extension of full funding for Medicaid disproportionate share hospital (DSH) payments. With funding for much of the federal government set to expire Jan. 19, Congress agreed on a continuing resolution that keeps all agencies fully operational until March. Medicaid DSH payments are guaranteed…

By Nick Hut January 22, 2024

New regulations are projected to bring providers a measure of relief from prior authorization headaches

Hospitals and other healthcare providers hailed a newly published final rule designed to improve prior authorization and the electronic exchange of health information. The Interoperability and Prior Authorization rule sets requirements for Medicare Advantage (MA) health plans, state Medicaid and CHIP programs, and Medicaid managed care organizations, all of which starting in 2026 must send…

By Nick Hut January 18, 2024

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…

By Nick Hut January 17, 2024

The big picture for healthcare in 2024, with Andrew Donahue

HFMA Policy Director Andrew Donahue discusses what trends and policy decisions will affect the healthcare industry in this election year.

By Erika Grotto January 15, 2024

Experts forecast a busy year for healthcare M&A even with changes to regulatory oversight

A more exacting system for regulatory reviews is a factor in the short-term outlook for healthcare mergers and acquisitions. New M&A guidelines from the Federal Trade Commission (FTC) and the U.S. Department of Justice (DOJ) add a wrinkle to the process of consummating deals, especially in the short term as the parties adjust to the…

By Nick Hut January 4, 2024
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