Payment Reimbursement and Managed Care

Understanding CJR Payment Reconciliation

Deirdre Baggot looks at the Comprehensive Care for Joint Replacement program one year in.

Deirdre Baggot April 27, 2017

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?

HFMA April 24, 2017

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 April 24, 2017

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 

HFMA April 20, 2017

Executive Summary: CMS 2018 IPPS Proposed Rule

This summary contains key financial and operational impacts from the FY18 IPPS proposed rule, published by CMS.

HFMA April 20, 2017

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.

David Koepke April 18, 2017

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.

Lola Butcher April 11, 2017

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.

J. Stuart Showalter April 10, 2017

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. 

HFMA April 10, 2017

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?

HFMA April 7, 2017
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