Managed Care

Navigating toward successful contract negotiations with health plans

A group of healthcare leaders discuss various tactics they are using to negotiate better rates with payers and ensure payers’ commitment to accurate, timely payment.

HFMA May 1, 2024

The Medicaid unwinding continues to pose issues one year in, but healthcare coverage appears stable

The unwinding of Medicaid continuous-enrollment requirements reached the one-year mark this month amid mixed measures of the effect on overall coverage. In one sense, the impact has exceeded all projections. Since states could begin disenrolling Medicaid beneficiaries on April 1, 2023, coverage for more than 19.6 million beneficiaries had been terminated as of April 4,…

Nick Hut April 12, 2024

The Payvider Movement Is Here.

This white paper examines how becoming a payvider drives additional revenue as well as strategic value.

HFMA April 1, 2024

Highlights of the Administration’s FY 2025 Budget

HFMA presents a summary highlighting healthcare-related proposals included in the President’s Budget for fiscal year 2025, based on materials released by the Biden Administration on March 11, 2024.

HFMA March 22, 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

HFMA Comments on Federal Independent Dispute Resolution Operations, Proposed Rule

HFMA presents its comment letter on CMS’ Federal Independent Dispute Resolution Operations Proposed Rule.

HFMA December 6, 2023

HFMA Comments on Federal Independent Dispute Resolution Process Fees Proposed Rule

HFMA presents its comment letter on CMS’ Federal Independent Dispute Resolution Process Fees Proposed Rule.

HFMA October 26, 2023

Medicaid Drug Misclassification Proposed Rule Summary

The rule proposes to implement policies in the Medicaid Drug Rebate Program (MDRP) related to legislative requirements addressing drug misclassification, as well as drug pricing and product data misreporting by manufacturers.

HFMA June 20, 2023

Ensuring Access to Medicaid Services Proposed Rule Summary

On May 3, 2023, CMS published in the Federal Register a proposed rule entitled “Medicaid Program; Ensuring Access to Medicaid Services” (88 FR 27960-28089). The rule proposes policies that take a comprehensive approach to improving access to care, quality and health outcomes, and better addressing health equity issues in the Medicaid program across fee-for-service, managed care delivery…

HFMA June 5, 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
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