Payment Reimbursement and Managed Care

CMS Open Door Forum: 2-Midnight Rule

On Tuesday, Sept. 26, 2013, CMS hosted a second, much anticipated, follow-up call to allow providers and other interested parties to ask questions pertaining to those areas of the two-midnight provision contained in the FY14 inpatient PPS final rule, which pertains to physician order and certification, inpatient hospital admission, and medical review criteria.

HFMA October 2, 2013

Learnings from the Front Lines: Physician Co-Management at Columbus Regional Health

Given the success of its surgical co-management program and employee gainsharing arrangement, the health system is considering a similar program for the ED and is positioning the organization to take on risk-based contracts.

Dennis Butts September 13, 2013

HFMA Comment Letter to CMS: FY14 Hospital Outpatient Prospective Payment Systems for Acute Care Hospitals

HFMA prepared a comment letter on key issues contained in CMS's 2014 Hospital Outpatient Prospective Payment Systems for Acute Care Hospitals.

HFMA September 6, 2013

FY14 IPPS Final Rule Overview

This fact sheet contains information on the updates to hospital payment rates under the inpatient prospective payment system for fiscal year 2014.

HFMA September 6, 2013

Fact Sheet: Standards for Consumer Assistance Programs for Healthcare Insurance Exchanges

This fact sheet provides details of CMS's rule outlining training requirements applicable to assistance personnel in healthcare insurance exchanges mandated under the Affordable Care Act.

HFMA August 9, 2013

At a Glance: What the Final Health Insurance Exchange Navigator Rule Means for Providers

Can hospitals and health systems serve as navigators or other assisters for the health insurance marketplaces? Here’s what the CMS final rule has to say.

HFMA July 31, 2013

When and How ERISA Can Protect Providers in an Audit Situation

Here are some specifics providers should know about ERISA and commercial audits.

Richard Quadrino July 31, 2013

CY14 OPPS Proposed Rule Fact Sheet

This fact sheet contains information on the proposed rule released by CMS updating payments to outpatient hospitals paid under the Medicare OPPS, and ambulatory surgical centers for CY14. The Centers for Medicare & Medicaid Services (CMS) released a proposed rule with comment period that updates payment policies and rates for services furnished to Medicare beneficiaries in hospital outpatient departments and establishes payments for services furnished in ambulatory surgical centers (ASCs) beginning January 1, 2014. In addition, CMS proposes to update and refine the requirements for the Hospital Outpatient Quality Reporting Program, the ASC Quality Reporting Program, and the Hospital Value-Based Purchasing Program.

HFMA July 26, 2013

Overview of Medicaid Disproportionate Share Hospital Allotment Reductions

This document summarizes the proposed rule requiring reductions to state Medicaid disproportionate share hospital allotments required under the ACA from FY14 through FY20. CMS released a proposed rule requiring aggregate reductions to state Medicaid disproportionate share hospital (DSH) allotments. The rule, required by the Affordable Care Act (ACA), sets forth aggregate reductions to state Medicaid DSH allotments annually from FY14 through FY20. The proposed rule also delineates the DSH health reform methodology (DHRM) to implement the annual reductions for FY14 and FY15, and proposes to add additional DSH reporting requirements for use in implementing the DHRM.

HFMA June 27, 2013

Medicare Disproportionate Share Hospital Payment Adjustment Fact Sheet

This document summarizes the major changes to the disproportionate share (DSH) payment adjustment that hospitals serving a significantly disproportionate number of low-income patients can qualify for, as outlined in the FY14 IPPS proposed rule.

HFMA June 20, 2013
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