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.
Big delays could be in store for early No Surprises Act arbitration cases
The portal for payment arbitration cases taking place under the No Surprises Act is open for business but could be facing a backlog of cases.
OIG calls out issues with denials of payment and services in Medicare Advantage
Medicare Advantage processes related to prior authorization hamper beneficiaries’ access to medically necessary care, according to a new report from the HHS Office of Inspector General.
Claims submitted to HRSA’s COVID-19 funds for uninsured and underinsured patients soon won’t be paid
Funds used to reimburse providers for supplying COVID-19-related services to the uninsured and underinsured will expire soon if Congress doesn’t act.
Healthcare spending projections for the next decade reflect an expectation of steadying trends post-pandemic
CMS actuaries say the healthcare spending spike of 2020 will be tempered across sectors and payers in upcoming years.
News Briefs: Federal funding bill addresses hospitals’ 340B eligibility concerns, extends telehealth waivers
A monthly roundup of top news for healthcare finance professionals.
Healthcare pricing update: 2 experts call for greater regulation
Recent price increases have been slower in healthcare than in the economy at large, but two healthcare economists say the long-term price trends should be addressed through regulation.
8 ways healthcare providers can smooth the DRG audit process
A health system’s financial sustainability depends on its being paid appropriately for the services it delivers. Yet routine payer audits can all too often result in downgrades of a health system’s billed diagnosis-related groups (DRGs), resulting in lower payment. It therefore behooves health systems to be well prepared for such audits and thoroughly understand why payers’ are most inclined to take such action.
Federal judge rules for providers in a case about a key component of the new surprise billing regulations
A federal judge found in favor of the Texas Medical Association in a case about the arbitration process that is being implemented as part of the No Surprises Act.
Small study finds health systems lagging in providing value-based payment incentives to physicians
Despite the increasing proliferation of alternative payment models, a new study finds that health systems generally don’t give physicians financial incentives to improve the value of care delivery.