Payment Reimbursement and Managed Care

Ask the Experts: Non-Contracted Insurer Payment Rates

How can providers respond when non-contracted insurers offer payments limited to some share of Medicare payments for a given service?

HFMA January 12, 2016

HFMA Comments on the CMS Discharge Planning Proposed Rule

HFMA comments on the CMS proposed rule on Medicare and Medicaid Programs: Revisions to Requirements for Discharge Planning for Hospitals, Critical Access Hospitals, and Home Health Agencies.

HFMA January 7, 2016

CY16 OPPS Final Rule Fact Sheet

This fact sheet highlights 2016 payment rate updates to outpatient hospitals and ambulatory surgical centers under the Medicare Outpatient Prospective Payment System (OPPS).

HFMA December 28, 2015

HFMA Comprehensive Care for Joint Replacement Final Rule Executive Summary

This Executive Summary provides the top 10 issues providers need to understand from the Comprehensive Care for Joint Replacement (CJR) final rule, published in the November 24, 2015, Federal Register.

HFMA December 22, 2015

HFMA’s Regulatory Sound Bites: An Overview of the Final 2016 Inpatient Prospective Payment System Rule

This presentation provides a summary of 2016 inpatient prospective payment system updates that affect inpatient acute care hospitals.  

HFMA December 15, 2015

Executive Summary – CY 2016 OPPS Final Rule

This summary features the top 10 issues providers need to understand from the CY16 outpatient prospective payment system (OPPS) final rule, published in the November 13, 2015, Federal Register.

HFMA December 7, 2015

HFMA Legislative Update Bipartisan Budget Act of 2015

This legislative update provides answers to questions pertaining to Section 603 of the Bipartisan Budget Act of 2015 implementing (with limited exemptions) site neutral payments for new Provider-Based Hospital Outpatient Departments.

HFMA November 18, 2015

Utilization Review Reduces Inpatient Denials

Covenant Health’s utilization review strategies have helped the health system recoup the difference between inpatient and observation status payments.

Karen Wagner November 17, 2015

Discharge Planning CMS Proposal

CMS has published a proposed rule to modernize discharge planning requirements to improve patient care, reduce complications, and avoid readmissions.

HFMA November 17, 2015

HFMA Comments on the HRSA 340B Drug Pricing Program Omnibus Guidance

The 340B program stretches resources for care to indigent and at-risk populations. Without this program, these individuals would find more difficulty in finding ready access to care and medications.

HFMA October 28, 2015
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