Medicare Payment and Reimbursement

In new final rule, CMS looks to claw back billions in overpayments to Medicare Advantage health plans

CMS has confirmed a new approach to its auditing of payments directed to Medicare Advantage health plans, but the agency says the regulatory burden on providers should not increase. A newly published final rule on risk adjustment data validation (RADV) establishes that CMS will use an extrapolation methodology to recoup overpayments to MA plans beginning…

Nick Hut February 3, 2023

Healthcare News of Note: 100 hospitals receive funding for new physician residency slots to boost healthcare access

CMS distributed 200 Medicare-funded physician residency slots to 100 hospitals, aiming to bolster healthcare access in areas with a shortage of qualified professionals. Overall cancer mortality has dropped 33% since 1991, averting an estimated 3.8 million cancer deaths, according to the American Cancer Society’s latest report. Patients’ ratings of specialist care were markedly higher when…

Deborah Filipek January 30, 2023

News Briefs: 2023 brings a steep fee hike for No Surprises Act arbitration cases

The No Surprises Act’s independent dispute resolution (IDR) process has become more expensive for healthcare stakeholders. For the new year, the nonrefundable administrative fee due from each party involved in any payment dispute that goes to arbitration increased from $50 to $350, according to a Dec. 23 memo from CMS’s Center for Consumer Information and…

Nick Hut January 27, 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

Key points to know in recently proposed rules for Medicare Advantage and the ACA marketplaces

A proposed rule for health plans in Medicare Advantage has provisions designed to stem overreach in prior authorization processes.

Nick Hut January 20, 2023

Seeking to phase out Medicare DSH payments, MedPAC outlines potential changes to reimbursement for safety net providers

Revamped formulas for hospitals and physicians would be designed to better target payments to providers that treat larger shares of low-income Medicare beneficiaries.

Nick Hut January 18, 2023

Remedies for 340B underpayments remain up in the air after court declines to provide guidance

A federal court is allowing HHS to decide on remedies covering Medicare underpayments to hospitals for 340B drugs.

Nick Hut January 11, 2023

Healthcare News of Note: What healthcare sector innovations are consumers most excited about?

Some 48% of healthcare consumers surveyed said improved insight into how much care would cost was the No. 1 item they were excited about when it came to innovation in healthcare. Employers can expect an increase of more than 20,000% in adolescent mental health telehealth costs, according to a study showing telehealth appointments cost an…

Deborah Filipek January 5, 2023

Medicare contractors should more closely examine providers’ bad debt claims, HHS watchdog says

Medicare administrative contractors (MACs) soon could apply more scrutiny to providers’ reported bad debts if CMS implements recommendations from the HHS Office of Inspector General (OIG). OIG in December issued a report in which it examined bad-debt reimbursement claims on Medicare cost reports spanning 2016 through 2018 for 67 randomly selected providers (including 29 hospitals). In those…

Nick Hut January 3, 2023

Beyond the News: Nick and Shawn discuss No Surprises, disruptors and everything else that made healthcare industry headlines in 2022

HFMA Senior Editor Nick Hut and HFMA Policy Director Shawn Stack discuss the top stories of 2022 in this special year-end episode.

Erika Grotto December 27, 2022
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