Payment Reimbursement and Managed Care

Winning Direct Contracts with Employers

Pacific Business Group on Health, a leader in direct contracting, uses an extensive evaluation process to choose the provider organizations for its Employers Centers of Excellence Network.

Lola Butcher July 11, 2016

Hospitals with PBGH Joint Replacement Contracts

Pacific Business Group on Health (PBGH), a membership organization that includes many of America’s largest healthcare purchasers, has developed direct contracts for joint replacements, spine procedures, and bariatric surgery with hospitals across the country.

Sidebar July 11, 2016

Forum Webinar: Bundled Payment Models: CJR and More

During this May 17, 2016, webinar, a hospital leader and a bundled payment expert shared their perspectives about the challenges of  implementing bundled payment programs, specifically related to orthopedic episodes and physician engagement.

HFMA July 1, 2016

Medicare Program: Medicare Clinical Diagnostic Laboratory Tests (CDLTs) Payment System Final Rule Summary

On June 17, 2016, CMS placed on public display a final rule, implementing revisions to the payment methodology for clinical diagnostic laboratory tests (CDLTs) paid under the Clinical Laboratory Fee Schedule (CLFS). The implementation date for the rule is January 1, 2018.

HFMA July 1, 2016

HFMA Comments on CMS’s MACRA Proposed Rule (CMS 5517-P)

HFMA submitted a comment letter to CMS on the MACRA Proposed Rule published in the May 9, 2016, Federal Register.

HFMA June 27, 2016

HFMA Summary: MSSP Revised Benchmark Rebasing Methodology Final Rule

The Centers for Medicare and Medicaid Services (CMS) published a final rule that would make important changes to the benchmarking rebasing methodology used in the Medicare Shared Savings Program (MSSP), among other changes.

HFMA June 21, 2016

Executive Summary – Final MSSP Benchmarking Rule

This document summarizes the Centers for Medicare & Medicaid Services's (CMS's) long awaited rule finalizing changes to the Medicare Shared Savings Program (MSSP) benchmark rebasing methodology, published in the June 10, 2016, Federal Register.

HFMA June 17, 2016

HFMA Comments on CMS’s FY17 IPPS Proposed Rule (CMS 1665-P)

HFMA submitted a comment letter to CMS on the FY17 Medicare Program Proposed Rule published in the April 27, 2016, Federal Register.

HFMA June 16, 2016

Executive Summary: CMS MACRA Proposed Rule

Important details of the May 9, 2016, Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) proposed rule are highlighted in this summary.

HFMA May 16, 2016

Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Proposed Rule Summary

This document provides a summary of the proposed rule establishing the Merit-based Incentive Payment System (MIPS) for MIPS eligible clinicians or groups under the Physician Fee Schedule (PFS) and incentives for participation in certain alternative payment models (APMs).

HFMA May 13, 2016
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