Payment Reimbursement and Managed Care

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

CY16 Medicare Physician Fee Schedule Proposed Rule Fact Sheet

CMS has released a proposed rule revising payment polices under the Medicare Physician Fee Schedule for calendar year 2016 (CY16).

HFMA October 20, 2015

FY16 IPPS Final Rule Fact Sheet

This document summarizes the updates to the reimbursement payment rates to hospitals under the inpatient prospective payment system for FY16.

HFMA September 24, 2015

HFMA Comments on CMS’s CY16 Physician Fee Schedule Proposed Rule

HFMA comments on the 2016 Medicare Program; revisions to payment policies (including advance care planning) under the physician fee schedule for CY 2016.

HFMA September 18, 2015

340B Drug Pricing Program Proposed Guidance Summary

This executive summary highlights important components of the Health Resources and Services Administration’s (HRSA) proposed 340B “Mega-Guidance.”

HFMA September 18, 2015

HFMA Comments on CMS’s CCJR Payment Model Proposed Rule

HFMA comments on CMS’s proposed rule for Comprehensive Care for Joint Replacement (CCJR) Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services.

HFMA September 17, 2015
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