Prior Authorization and Interoperability for Medicare Advantage, Medicaid, CHIP, and QHPs Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule designed to improve the electronic exchange of health care data and streamline prior authorization processes, while continuing to encourage interoperability in the healthcare market.
Healthcare News of Note: Newest nurses now fill the greatest number of 12-hour shifts
Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: New nurses fill the largest number of shifts, some heart failure patients find the cost of medications unaffordable, and inaccuracies in CMS data make it difficult to address healthcare disparities.
Healthcare News of Note: U.S. Surgeon General says the nation must stop health worker burnout
Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: U.S. Surgeon General says healthcare worker burnout is a national issue that must be addressed, the Digital Health for Equitable Health Alliance was just launched, and a survey shows funding is needed for ACOs to provide more home-based services.
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.
Healthcare News of Note: Patients in the U.S. shouldered more than $21B in cancer care costs in 2019
Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: U.S. patient cancer care costs totaled $21.09 billion in 2019, healthcare safety scores fell amid the pandemic, and states are leveraging MCO contracts to improve community SDOH.
Healthcare News of Note: Average billed charge for complex COVID-19 hospitalizations is more than three times the allowed amount
Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: $317,810 is the average charge for a complex COVID-19 hospitalization, the pandemic has had a unique impact on people with disabilities, and transitional clinic care brings posthospitalization benefits for medically complex patients.
Healthcare News of Note: Few consumers are using publicly posted negotiated prices to comparison shop for healthcare services
Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: Little use of price transparency information to comparison shop for healthcare services, the nursing shortage being felt throughout the U.S., and cash payers being charged more for the same services than patients with insurance.
Hospitals not adhering to CMS’s cost transparency rule may eventually find their public images tarnished by their noncompliance
Hospitals could lose patients and their good reputations if CMS makes public the names of those noncompliant with the latest price transparency rule.
Healthcare News of Note: CMS offers new guidance on making healthcare price transparency information searchable
CMS guidance on making price transparency information searchable, a correlation between job loss and nurse suicides and using incentives to move hospitals away from just-in-time PPE inventories are all topics covered in this week’s Healthcare News of Note.
Provider Interest in MA Plans Surges
Most plans expected to enter the Medicare Advantage (MA) market over the next two years will be provider-sponsored, according to a health plan adviser.