Payment Reimbursement and Managed Care

Medicaid DSH payment cut barely averted as House, Senate pass short-term federal funding

Hospitals received a last-day reprieve from substantial cuts to Medicaid disproportionate share hospital (DSH) payments, with House leaders reversing course Sept. 30 and ushering through a six-week government funding package. Language in the bill ensures a four-year, $32 billion Medicaid DSH cut will not take effect before Nov. 17. Most importantly, the bill bought time…

Nick Hut October 4, 2023

Update: Medicaid DSH payment cut averted as House, Senate pass short-term federal funding

Note: The headline and lead section of this article were updated Oct. 1 with news of a six-week government funding extension that delays the Medicaid DSH cuts and pays for other healthcare programs. The article originally was published Sept. 28 under the headline, “An $8 billion Medicaid DSH cut is closer to happening as a…

Nick Hut October 1, 2023

Risky business: What every CFO should know before taking on risk

As a health system leader, how can you ensure your organization is making the right moves to take on risk in an evolving landscape for payment? Check out a handful of key capabilities to focus on in this article.

HFMA September 29, 2023

PFC USA’s partnership approach ensures healthcare clients tackle regulatory and patient satisfaction issues

Review some tips from a company with 6.5 years of hands-on experience in helping its healthcare clients handle concerns in healthcare such as workforce shortages and a volatile regulatory environment.

HFMA September 29, 2023

HFMA Comments on CY 2024 OPPS/ASC Proposed Rule

HFMA presents its comment letter to CMS on the CY 2024 OPPS/ASC Proposed Rule.

HFMA September 26, 2023

CMS pressures states to restore Medicaid coverage for some beneficiaries who have been disenrolled

CMS says a recent edict to state Medicaid programs has partially stanched the ongoing wave of disenrollments in the program, with about 500,000 beneficiaries set to regain coverage they had lost and “many” others protected from disenrollment going forward. As described in a Sept. 21 summary, 29 states plus Washington, D.C., have acknowledged a systemic…

Nick Hut September 25, 2023

HHS sets new administrative fee to be paid by parties in No Surprises Act independent dispute resolution cases

Oct. 6 update: The lead section of this article was updated where noted with news about the arbitration portal. The administrative fee for taking out-of-network payment disputes to arbitration under the No Surprises Act in 2024 would be significantly lower than it was for much of 2023, but triple the current rate, according to proposed…

Nick Hut September 22, 2023

American providers remain in reimbursement limbo during IDR failure

HFMA and its member healthcare providers are growing more concerned over the extended delay of reimbursement from group health plans subject to the unresolved No Surprises Act IDR regulations and guidance. HFMA members continue to report that numerous health plans persist in determining very low rates for calculating the Quality Performance Assessment (QPA) they are…

Shawn Stack September 20, 2023

As clock ticks toward massive Medicaid disproportionate share hospital cuts, proposed bill would bring relief

A congressional bill that would impose additional transparency requirements on providers also would offer a respite from a sizable cut to a key supplemental payment. A $32 billion reduction to Medicaid disproportionate share hospital (DSH) payments is scheduled to span four years, beginning when federal FY24 gets underway Oct. 1. The Lower Costs, More Transparency…

Nick Hut September 19, 2023

Legislation to enhance healthcare pricing and billing transparency takes a big step forward in the House

A slew of provisions on healthcare transparency took a step closer to becoming federal law as three House committees last week merged separate bills into a single draft. The resulting bill is just about set for consideration by the full House, where bipartisan support for the major provisions was apparent in the committee phase. The…

Nick Hut September 14, 2023
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