Health Plan Payment and Reimbursement

Hospital payments have been substantially affected by the Change Healthcare cyberattack, report finds

Newly published data reflect the extent of the payment loss experienced by hospitals and health systems during the first month or so after the Change Healthcare cyberattack. A report (registration required) published in mid-May by Strata finds that gaps in expected revenue ranged from 16.5% to 17.9% per hospital for Q1. The insights were culled…

Nick Hut May 20, 2024

The federal policy response to the Change Healthcare cyberattack

Note: This information is excerpted from HFMA’s running coverage of the cyberattack that disabled operations at Change Healthcare. On March 10, HHS and the Department of Labor sent a letter encouraging commercial payers to do their part to help financially strained providers nearly three weeks after the cyberattack on Change Healthcare. “Larger payers in particular…

Nick Hut March 14, 2024

Cyberattack on Change Healthcare brings turmoil to healthcare operations nationwide

Resources A list of payer contacts for providers to inquire about advance payments An FAQ on Medicare accelerated and advance payments Recommendations and resources for HFMA members Link to UnitedHealth Group and Optum incident pages May 10 updates Our May 3 update (see below) included news on the issue of breach notifications, specifically UnitedHealth Group’s…

Nick Hut February 25, 2024

New data shows providers continuing to win most No Surprises Act independent dispute resolution cases

Providers won a large majority of disputes initiated during the first half of 2023 through the No Surprises Act’s arbitration portal for adjudicating out-of-network payments, according to newly published data. HHS and the U.S. Departments of Labor and Treasury released public-use files (available to download here under “2023 Reporting Year”) showing the outcome of every…

Nick Hut February 21, 2024

CMS’s 2025 advance rate notice for Medicare Advantage brings potential concern for providers

Medicare Advantage (MA) health plans are projected to reap a 3.7% revenue increase in 2025, but provider payments could be affected by a decrease in plan benchmarks, per data shared in CMS’s annual advance notice. If finalized, the estimated 0.16% average reduction in base payments to plans could have consequences for care delivery, one provider…

Nick Hut February 7, 2024

News Briefs: A new fee is set for using the No Surprises Act arbitration portal

Bringing out-of-network payment disputes to arbitration under the No Surprises Act in 2024 will be less expensive than previously proposed. In a final rule, the U.S. Departments of Health and Human Services, Labor and Treasury established the administrative fee for using the independent dispute resolution (IDR) portal at $115 per case, effective Jan. 22. That’s…

Nick Hut January 30, 2024

Biden administration announces effort to make healthcare more competitive and transparent

Providers and insurers should be on the lookout for the Biden administration to hand down regulations and guidance intended to promote competition in healthcare. The White House in December released a fact sheet stating its position that a lack of competition affects healthcare prices and accessibility for consumers. Drug costs have been a target of…

Nick Hut January 30, 2024

Employer-sponsored healthcare coverage would benefit from better access to data, Congress is told

Employers can stimulate efforts to improve the value of healthcare, but they need help in the form of better access to claims data and prices, according to testimony at a recent congressional hearing. With those tools in hand, employers can more easily forge provider partnerships that lower costs and raise healthcare quality, health benefit administrators…

Nick Hut January 26, 2024

Definition of “Employer”—Association Health Plans Proposed Rule Summary

HFMA presents a detailed summary of the proposed rule published by the Employee Benefits Security Administration that would rescind the similarly titled rule finalized in 2018 (83 FR 28912) that expanded the regulatory definition of “employer” under the Employee Retirement Income Security Act of 1974.

HFMA January 3, 2024

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…

Nick Hut December 20, 2023
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