HFMA Comments on Medicare Part B Inpatient Hospital Billing and the RAC Program
HFMA is concerned with aspects of the RAC program that violate many of HFMA’s principles of a reformed payment system. Comments focused on rebilling for medically necessary services and the timeframe.
Successfully Negotiating Managed Care Contracts
“The more an organization solidifies its own expectations for contract negotiation and appreciates the needs of the payer, the more likely it is to reach an acceptable agreement,” says Paula Dillon, director of managed care for Rockford Health System.
HFMA Comment Letter: Second Draft of Sustainable Growth Rate Repeal & Reform Proposal
Read HFMA's comments to the chairs of the House of Representatives' Ways and Means and Energy and Commerce Committees and their respective Health Subcommittees on their drafted framework for legislation to replace the SGR.
Medicare Part B Inpatient Billing in Hospitals Proposed Rule Fact Sheet ;reasonable and necessary;Medicare Part A claim denial;inpatient admission
This fact sheet highlights the CMS's proposed rule, Medicare Program; Part B Inpatient Billing in Hospitals, which would revise the current billing policy under Medicare Part B following a denial of a Medicare Part A inpatient claim for services not reasonable and necessary.
CY13 Medicare Physician Fee Schedule Final Rule Fact Sheet
CMS has issued a final rule regarding revisions to payment policies under the Medicare Physician Fee Schedule for calendar year 2013 (CY13).
CY13 OPPS Final Rule Fact Sheet
This fact sheet provides information on the updates to Medicare payment rates for hospital outpatient services paid under the outpatient prospective payment system and the ambulatory surgical center payment system for calendar year 2013.
HFMA’s Comment Letter to CMS on Hospital Value-Based Purchasing
HFMA submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the weighting of the HCAHPS domain within the CMS Hospital Value-Based Purchasing Program.
Ask the Experts Answer: Urgent Care Center
Q: We are opening an urgent care center that will be hospital-based. The consulting team that is setting-up the billing suggests that we have two different charge slips and two different prices -- one for self pay and one for insurance patients. I am not comfortable with this recommendation and would like guidance on charging two different prices.
Ask the Experts Answer: Provider Refunds for Insured Patients
Q: Do you know of any policy/legislation or general practices regarding a provider refunding a payer if the patient was authorized but then later found by the payer to be uncovered because they are secondary?
Ask the Experts Answer: Industry Standard Off-Billed Charge
We are a niche DME provider trying to set a patient pay rate for those who are either under insured, don’t have insurance or are out-of-network. What would an industry standard discount off-billed charge look like for those without benefits and when we don’t incur the cost to bill the third party?