Health Plan Payment and Reimbursement

‘Carve outs’ among keys in managed care negotiations

Carve outs are a critical tool hospitals should use in negotiations with health plans to ensure the costs of more expensive conditions are covered.

Rich Daly July 16, 2020

Implement these 6 safeguards against fraud accusations in telehealth

Healthcare providers should take care to comply with payer policies around telehealth.

Lisa A. Eramo July 10, 2020

Hospitals scramble to meet price transparency requirements after court decision

Hospitals have a lot of costly work to do to meet CMS requirements to publicly post the rates they negotiate with health plans.

Rich Daly July 7, 2020

As states anticipate Medicaid shortfalls, hospitals urge Congress to bolster commercial plan enrollment

Hospitals are emphasizing steps to boost commercial health plan enrollment over Medicaid enrollment.

Rich Daly May 29, 2020

The increased uninsured population and changes in coverage for others requires healthcare finance departments to revise their practices

As a result of unemployment, insurance coverage has changed for millions of Americans, making it more important than ever for healthcare providers to offer financial counseling, community outreach and patient education.

Chad Mulvany, FHFMA May 21, 2020

Key considerations for revenue cycle teams to optimize coding and maximize revenue during COVID-19

Providers should make sure they fully understand various COVID-19 codes that can enhance payment from CMS and serve as important claims data.

Emmel Golden, MD, FCCP, CCDS May 6, 2020

April 23 deadline looms for hospitals in ‘high-impact’ COVID-19 areas to provide information to receive CARES Act funds

Hospitals hit by COVID-19 cases face a tight deadline to let HHS know they are interested in new funding that will be distributed next week.

Rich Daly April 23, 2020

COVID-19’s impact on healthcare purchasers’ balance sheets will drive cost reduction efforts after the pandemic

HFMA's Chad Mulvany anticipates a combination of efforts to reduce the growth in per unit prices of healthcare and to reduce the total cost of care on the healthcare delivery system side after the pandemic.

Chad Mulvany, FHFMA April 17, 2020

Rural hospital finances hit hard by looming threat of COVID-19 as leaders scramble to preserve cash

Although most healthcare providers are likely to take a financial hit from the coronavirus pandemic, rural hospitals are especially vulnerable and are scrambling to preserve cash.

Susan Birk April 7, 2020

Will the value-based movement be re-energized in the wake of the coronavirus pandemic and its impact on national health expenditure?

HFMA's Chad Mulvany says he hopes healthcare payers and providers will be able to use the coronavirus crisis and the resulting impact on the national health expenditure as a catalyst to revive the value-based movement.

Chad Mulvany, FHFMA April 2, 2020
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