Contracting

Published data quantify how cost increases will continue to affect the healthcare industry next year

The cost to treat patients will accelerate next year, with ramifications across the healthcare industry, according to newly published projections. PwC’s Health Research Institute reported that the cost of providing care will increase by 7% in 2024, up from a 6% increase this year and 5.5% in 2022. A 7% increase would tie 2021 for…

Nick Hut September 7, 2023

Summary: 10 vital responses to healthcare disruption

Note: This article is a summary of a report on HFMA’s Spring Thought Leadership Retreat. The full report is available to download. Disruption is reverberating throughout the healthcare industry, and it’s incumbent on legacy organizations to develop strategic responses for the benefit of their consumers, their communities and themselves. With that overarching challenge becoming ever…

Nick Hut August 30, 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

10 Vital Responses to Healthcare Disruption

Disruption is reverberating throughout the healthcare industry, and it’s incumbent on legacy organizations to develop strategic responses for the benefit of their consumers, their communities and themselves. With that overarching challenge becoming ever more pressing, HFMA’s 2023 Spring Thought Leadership Retreat brought together leaders from across the industry May 4-5 in Atlanta to consider approaches…

Nick Hut July 11, 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

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

How managed care contracting strategies promote operational resilience

Read this article for an in depth look on several strategic steps for healthcare leaders to take to benefit their organization's managed care contracting.

HFMA April 28, 2023

Final rule for Affordable Care Act marketplace plans could expand contracting opportunities for certain types of providers in 2024

Final 2024 regulations for health plans participating in the Affordable Care Act (ACA) insurance marketplaces are designed to improve equitable access to behavioral healthcare, potentially meaning a wider array of providers will have a chance to be included in networks. As of 2023, a participating plan must have at least 35% of available essential community…

Nick Hut April 26, 2023

Healthcare disruptor Glen Tullman says providers need more of a consumer-centric approach

One of the country’s most prominent healthcare entrepreneurs has a warning for legacy healthcare stakeholders. “Many of you in the audience are leading major health systems, and you’re the hub for healthcare today,” Glen Tullman said during a presentation at the HIMSS Global Health Conference and Exhibition, which took place the week of April 17…

Nick Hut April 25, 2023
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