CMS and other stakeholders take steps to improve prior authorization in Medicare Advantage and beyond
Several recent developments point to an industrywide effort to ease the burden of prior authorization. Most notably, CMS on April 5 finalized a rule that includes provisions designed to improve prior authorization in Medicare Advantage (MA) starting with the 2024 plan year. The rule addresses a few aspects of prior authorization, among them the way…
Maryland’s all-inclusive population health payment model continues to show promise, but nonhospital spending poses a concern
An innovative payment model for Maryland healthcare providers has improved utilization, cost and quality thus far, but an increase in nonhospital spending requires further study. The Center for Medicare & Medicaid Innovation (CMMI) released an analysis of the first three years of Maryland’s Total Cost of Care Model, an effort to improve population health management.…
News Briefs: Financial and operational pressures continue for hospitals amid scattered positive signs
Recent financial data for the hospital industry illustrate continuing challenges even as some trends improve. Fitch Ratings released an analysis in early March that offers scant reason for optimism. Titled “Early NFP hospital medians show expected deterioration; will worsen,” it draws on data from hospitals with earlier 2022 financial year-ends. Those numbers show “materially weaker…
Best practices for relieving unprecedented cost pressures facing healthcare providers
Due to labor cost increases, inflation, declining Medicare reimbursements and other reasons, health systems across the nation are feeling a new financial strain after the height of the pandemic.
Medicare Drug Price Negotiation Program Guidance
HFMA presents a summary of CMS proposed initial guidance memorandum pertaining to the Medicare Drug Price Negotiation Program.
Healthcare News of Note: Medicare to negotiate reduced prices for 40 drugs by 2028, says study
Medicare drug price negotiation has the potential to benefit Medicare beneficiaries across some of the most common disease states.
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.
Medicare DSH Adjustment and Section 1115 Waiver Days Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule published by CMS that would change the policies on how the Medicare disproportionate share adjustment is determined, relating to the counting of days associated with individuals eligible for certain benefits provided by section 1115 demonstrations.
News Briefs: Healthcare industry disrupter CVS Health to shell out billions to buy Oak Street Health
A month after stating it hoped to gain a presence in primary care, CVS Health accomplished that goal with a massive deal that could fortify its efforts to advance value-based payment in healthcare. The proposed $10.6 billion acquisition of Oak Street Health, a provider of senior-focused primary care, adds to a portfolio of assets that…
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…