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.
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…
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…
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…
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.
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…
No Surprises Act end-of-year update: A new administrative fee is set, and the arbitration portal is fully functional
Bringing out-of-network payment disputes to arbitration under the No Surprises Act in 2024 will be less expensive than previously described. In a final rule, the U.S. Departments of Health and Human Services (HHS), Labor and Treasury set the administrative fee for using the independent dispute resolution (IDR) portal at $115 per case, effective 30 days…
The best of 2023 from HFMA’s editorial team
The HFMA editors share their favorite content from this year and provide a glimpse of what's to come in 2024.
Prior authorization in Medicare Advantage remains in the policy spotlight as 2024 regulations take effect
Healthcare policymakers and stakeholders continue to mull the need for guardrails to ensure optimal customer service among Medicare Advantage (MA) health plans. The American Hospital Association wrote a Nov. 20 letter to CMS stating that MA plans are looking to skirt policies designed to ensure straightforward coverage of essential healthcare services. These policies, finalized earlier…
6 steps to prepare now for looming information-blocking requirements
The 21st Century Cures Act includes provisions aimed at identifying and stopping information-blocking practices that interfere with reasonable seamless sharing of electric health information. The Office of the National Coordinator for Health Information Technology (ONC) defines such a practice as one “likely to interfere with the access, exchange, or use of electronic health information (EHI),…