Medicare Payment and Reimbursement

Overview of Medicaid Disproportionate Share Hospital Allotment Reductions

This document summarizes the proposed rule requiring reductions to state Medicaid disproportionate share hospital allotments required under the ACA from FY14 through FY20. CMS released a proposed rule requiring aggregate reductions to state Medicaid disproportionate share hospital (DSH) allotments. The rule, required by the Affordable Care Act (ACA), sets forth aggregate reductions to state Medicaid DSH allotments annually from FY14 through FY20. The proposed rule also delineates the DSH health reform methodology (DHRM) to implement the annual reductions for FY14 and FY15, and proposes to add additional DSH reporting requirements for use in implementing the DHRM.

By HFMA June 27, 2013

Medicare Disproportionate Share Hospital Payment Adjustment Fact Sheet

This document summarizes the major changes to the disproportionate share (DSH) payment adjustment that hospitals serving a significantly disproportionate number of low-income patients can qualify for, as outlined in the FY14 IPPS proposed rule.

By HFMA June 20, 2013

HFMA Comments on Medicare Part B Inpatient Hospital Billing and the RAC Program

HFMA is concerned with aspects of the RAC program that violate many of HFMA’s principles of a reformed payment system. Comments focused on rebilling for medically necessary services and the timeframe.

By HFMA May 20, 2013

HFMA Comment Letter: Second Draft of Sustainable Growth Rate Repeal & Reform Proposal

Read HFMA's comments to the chairs of the House of Representatives' Ways and Means and Energy and Commerce Committees and their respective Health Subcommittees on their drafted framework for legislation to replace the SGR.

By HFMA April 15, 2013

Medicare Part B Inpatient Billing in Hospitals Proposed Rule Fact Sheet ;reasonable and necessary;Medicare Part A claim denial;inpatient admission

This fact sheet highlights the CMS's proposed rule, Medicare Program; Part B Inpatient Billing in Hospitals, which would revise the current billing policy under Medicare Part B following a denial of a Medicare Part A inpatient claim for services not reasonable and necessary.

By HFMA April 5, 2013

CY13 Medicare Physician Fee Schedule Final Rule Fact Sheet

CMS has issued a final rule regarding revisions to payment policies under the Medicare Physician Fee Schedule for calendar year 2013 (CY13).

By HFMA January 11, 2013

CY13 OPPS Final Rule Fact Sheet

This fact sheet provides information on the updates to Medicare payment rates for hospital outpatient services paid under the outpatient prospective payment system and the ambulatory surgical center payment system for calendar year 2013.

By HFMA December 19, 2012

HFMA’s Comment Letter to CMS on Hospital Value-Based Purchasing

HFMA submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the weighting of the HCAHPS domain within the CMS Hospital Value-Based Purchasing Program.

By HFMA December 19, 2012

Ask the Expert: CMS Statements for Medicare Patients

States--not CMS--have regulations in place related to timely patient notification of the availability of financial assistance/charity, as well as a statement that includes a summary of charges.

By HFMA October 25, 2012

Ask the Expert Answer: Fiscal Intermediary and Medicare Bad Debt

 Q Our FI is currently disallowing our Medicare bad debts which we claimed and wrote off in accordance with our charity care policy. We believe our Medicare deductible copay amounts that we did not collect because the patient was indigent

By HFMA October 25, 2012
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