Medicaid Payment and Reimbursement

How leveraging artificial intelligence in utilization management can enhance your revenue cycle

This white paper dives into how AI will help make healthcare sustainable and provide more of a focus on patient care. The goal is to decrease industry challenges and create new efforts to reduce the administrative cost of healthcare.

HFMA July 27, 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

As anticipated, the start of the Medicaid unwinding process has taken a toll on coverage

Fears among healthcare policymakers that the end of the COVID-19 public health emergency would sow chaos in Medicaid have been realized, leading the Biden administration to intensify its mitigation efforts. The end of Medicaid continuous-enrollment provisions is affecting the program in many states. In 21 states that had begun the “unwinding” process since April 1,…

Nick Hut June 15, 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

Beyond the News: What the end of the PHE means for Medicaid

HFMA Senior Editor Nick Hut and HFMA Policy Director Shawn Stack discuss the end of the public health emergency and what it means for Medicaid as well as a recent blog post from Stack on price transparency.

Erika Grotto April 3, 2023

Highlights of the Administration’s FY 2024 Budget

HFMA presents a summary of healthcare-related proposals included in the President’s budget for fiscal year 2024, released by the Biden Administration on March 9, 2023.

HFMA March 21, 2023

Here comes the Medicaid unwinding: The healthcare industry braces for coverage disruptions

A potentially tumultuous period for revenue cycle teams in particular and the U.S. healthcare system in general begins April 1, with the phasing out of a three-year run of Medicaid continuous enrollment. The so-called Medicaid “unwinding” originally was connected to end of the COVID-19 public health emergency (PHE), which is scheduled for May 11. But…

Nick Hut March 15, 2023

Medicaid DSH Third-Party Payer Proposed Rule Summary

HFMA presents a detailed summary of the proposed rule that would address legislative changes to the hospital-specific limit on Medicaid DSH payments as a result of the Consolidated Appropriations Act, 2021.

HFMA March 9, 2023

During a potentially tumultuous Congress, healthcare stakeholders should communicate their policy priorities

With the 118th Congress bringing the potential for policy upheaval, one of the best things healthcare stakeholders can do is make themselves heard on Capitol Hill. The new Republican majority in the House of Representatives has signaled its intent to use the federal debt ceiling as leverage in budget negotiations. President Joe Biden and the…

Nick Hut January 24, 2023

Massive federal spending bill alleviates reimbursement concerns for hospitals, but less so for physicians

Healthcare provider advocates applauded the inclusion of key reimbursement relief measures and other policies in a proposed federal spending bill for FY23, although physician groups expressed concern about the outlook for their constituents. With a divided Congress looking to muster the votes to pass the legislation before a self-imposed deadline of week’s end, the bill includes many…

Nick Hut December 20, 2022
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