Navigating toward successful contract negotiations with health plans
A group of healthcare leaders discuss various tactics they are using to negotiate better rates with payers and ensure payers’ commitment to accurate, timely payment.
FY 2025 Inpatient Psychiatric Facilities PPS Proposed Rule Summary
HFMA presents a detailed summary of the FY 2025 Inpatient Psychiatric Facilities Prospective Payment System proposed rule, published in the April 3, 2024.
Why the Medicare physician fee schedule is sheer madness
Amid the complexities of U.S. healthcare, there is probably no construct that’s more byzantine than the Medicare Physician Fee Schedule (MPFS) — the program’s elaborate system of paying physicians and other clinicians (including nurse practitioners, physician assistants and clinical psychologists) for more than 10,000 medical services.a In 2022, the schedule drove about $71.2 billion in…
A new 340B dispute resolution process could create more opportunities for providers
Regulatory updates to the administrative dispute resolution (ADR) process in the 340B Drug Pricing Program seem likely to expedite the filing of claims over manufacturers’ refusal to offer discounts on drugs distributed at contract pharmacies. HHS and the Health Resources and Services Administration (HRSA), which administers the 340B program, published a final rule that modifies…
FY 2025 Inpatient Rehabilitation Facility PPS Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule published by CMS on the Medicare inpatient rehabilitation facility prospective payment system updates for FY 2025.
FY 2025 IPPS/LTCH PPS Proposed Rule Summary
HFMA presents a detailed summary of the FY 2025 IPPS/LTCH prospective payment system proposed rule, released by CMS on April 10, 2024.
How a health system goes above and beyond in its price transparency efforts
By maintaining a patient-centric perspective, hospitals and health systems can find opportunities to look beyond regulatory requirements and incorporate top-class price transparency models, according to a recent online discussion. “We want to, first and foremost, empower and equip our customers to make informed decisions about their healthcare services and really shop for the best value,”…
FY 2025 Hospice Payment Rate Update Proposed Rule Summary
HFMA provides a detailed summary of the proposed rule updating the Medicare hospice payment rates, wage index and Hospital Quality Reporting Program for FY 2025.
CMS calls for hospitals to be subject to a new bundled payment model and data-reporting requirements
Notable policies in Medicare’s FY25 proposed rule for inpatient hospital care and long-term care hospitals include the formation of a mandatory bundled payment model and requirements for hospital data reporting. Although the proposed payment rate was the headlining aspect of the rule for hospitals, the policy developments could have a longer-term impact on segments of…
The Medicaid unwinding continues to pose issues one year in, but healthcare coverage appears stable
The unwinding of Medicaid continuous-enrollment requirements reached the one-year mark this month amid mixed measures of the effect on overall coverage. In one sense, the impact has exceeded all projections. Since states could begin disenrolling Medicaid beneficiaries on April 1, 2023, coverage for more than 19.6 million beneficiaries had been terminated as of April 4,…