Payment Reimbursement and Managed Care

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

OSF plans for value-based care in Medicaid

The majority (70%) of OSF HealthCare’s business is paid for by Medicare and Medicaid, prompting Mike Allen, FHFMA, MBA, the system’s CFO, to identify Medicaid as presenting the next big opportunity for assuming risk under a value-based care approach.  “Trying to wade into a value-based agreement for the Medicaid population is not for the faint…

Lola Butcher September 12, 2023

CY 2024 OPPS/ASC Proposed Rule Summary

HFMA presents a detailed summary of the proposed rule issued by CMS updating payments under the hospital outpatient prospective payment system and the ambulatory surgical center payment system for CY 2024.

HFMA September 8, 2023
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