Ask the Experts: Managing Health Plan Overpayments
I have heard there is a rule that health plans cannot recoup overpayments that are more than one year old. Does that stipulation vary by state, or is that a rule that is negotiable per contract?
Ask the Experts: Contracting with Small Health Plans
When negotiating with large and small health plans, what areas of comparison should I look at to be sure I am getting the same levels of service from the various plans?
HFMA Comments on CMS’s EPM IFR
HFMA submitted comments to CMS on EPMs; Cardiac Rehabilitation Incentive Payment Model; and Changes to the CJR; Delay of Effective Date interim final rule
Executive Summary: CMS 2018 IPPS Proposed Rule
This summary contains key financial and operational impacts from the FY18 IPPS proposed rule, published by CMS.
The Move to Office-Based Services Not Yet Showing Impact
Although commercial health plans have tried to equalize payments between hospital and office-based settings, hospital payments still remain higher and share of procedures by site have remained consistent.
Why Health Plans Are Easing Preauthorization
In an attempt to build cooperative working relationships with physicians, some health plans are trying to reduce the burden of preauthorization.
Managing the ACA’s Nondiscrimination Provisions
The ACA prohibits discrimination in health programs or activities that receive federal financial assistance. Healthcare providers face the challenges of preventing language barriers that may impact certain patients based on race, as well as current litigation on gender identify.
Electronic Claim Processing Can Save Millions of Work Hours
If providers fully adopt automated processes for claim transactions, a minimum of 1.1 million hours of administrative work could be saved per business week each year, according to a 2016 CAQH study.
Ask the Experts: Developing a Bundled Payment Team
Who are the main players within finance and other departments who are typically involved in developing bundled payments?
Tackling Preservice Pricing Plans
Despite evidence that patient demand for preservice pricing is growing, only 30 percent of patients are being offered pre-treatment cost estimates.