New guidance for No Surprises Act arbitration looks like an improvement for providers
Responding to a recent court ruling, the U.S. Department of Health and Human Services (HHS) has updated the application of criteria for deciding No Surprises Act (NSA) independent dispute resolution (IDR) cases. Certified IDR entities (i.e., arbitrators) received guidance March 17 instructing them to more directly consider multiple factors when deciding on an out-of-network payment…
Financial and operational pressures continue for hospitals amid some positive signs
New financial data for the hospital industry illustrate continuing challenges even as some trends improve. Fitch Ratings released an analysis in early March that offers scant reason for optimism. Titled “Early NFP Hospital Medians Show Expected Deterioration; Will Worsen,” it draws on data from hospitals with earlier 2022 financial year-ends. Those numbers show “materially weaker…
Affordability of healthcare is not enhanced when providers form health systems, studies find
The efficiencies gained when providers operate as a health system don’t always translate to care that is more cost-effective, according to two recently published JAMA studies on pricing. In one study, researchers with Harvard Medical School and the National Bureau of Economic Research (NBER) examined 2018 data from various sources, including CMS administrative data, IRS…
News Briefs: 2023 brings a steep fee hike for No Surprises Act arbitration cases
The No Surprises Act’s independent dispute resolution (IDR) process has become more expensive for healthcare stakeholders. For the new year, the nonrefundable administrative fee due from each party involved in any payment dispute that goes to arbitration increased from $50 to $350, according to a Dec. 23 memo from CMS’s Center for Consumer Information and…
Key points to know in recently proposed rules for Medicare Advantage and the ACA marketplaces
A proposed rule for health plans in Medicare Advantage has provisions designed to stem overreach in prior authorization processes.
Most healthcare organizations want to augment current EHR workflows and would consider flexible outsourcing contracts
This pulse survey shows that there is no one-size-fits-all solution for managing today’s revenue cycle challenges. Savvy healthcare organizations know they need a combination of actionable insights and high-performance work teams to be successful.
Healthcare News of Note: Long COVID may affect a minimum of 10 million working-age adults
Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: Long COVID could impact healthcare coverage for many, the national uninsured rate reaches an all-time low, and more nurses are planning on leaving the profession.
News Briefs: Hospital labor costs rose by almost 40% between 2019 and early 2022
As published in hfm magazine, a monthly roundup of top news for healthcare finance professionals.
Hospital prices increasingly are coming under a microscope
Newly issued reports and policy recommendations are examining hospital prices in the context of high healthcare costs.
2023 regulations for Medicare Advantage and ACA marketplaces seek to enhance network adequacy standards
HHS and CMS recently released sets of 2023 regulations that affect provider network adequacy standards in Medicare Advantage and the Affordable Care Act insurance marketplaces.