Reimbursement

News Briefs: The expiration of the COVID-19 PHE brings an end to key provisions

The termination of the COVID-19 public health emergency (PHE) on May 11 meant providers lost many of the accommodations and regulatory flexibilities that were in place since Jan. 31, 2020. For example, Medicare’s 20% add-on payment for treating COVID-19 cases in the inpatient setting no longer is available. With reported cases and hospitalizations steadily trending…

Nick Hut May 30, 2023

Healthcare providers seeing more diagnosis-related group downgrades and ghost denials

Each year, tens of millions of medical claims will be denied by healthcare payers. One executive director led a session with more than a dozen attendees highlighting their experiences with DRG downgrades and lessons learned to help other organizations better measure, manage and successfully appeal these complex denials.

HFMA May 30, 2023

The state of Medicare Advantage: As the program grows, healthcare stakeholders express concerns

As seen during a recent virtual conference, the accelerating expansion of Medicare Advantage (MA) has been accompanied by tension over growing pains such as regulatory issues. “I think MA was set up really well, but like anything else there’s sort of a moment where you have to look at the program and say: How do…

Nick Hut May 30, 2023

6 actions for physician practices on signing risk-based contracts

Physician practices are continuing to make the move into value-based payment, and for many, such contracts will present a substantial learning curve. 

Clifford Frank, MHSA May 26, 2023

CMS issues RFI to gather best practices for identifying and supporting safety net hospitals

As part of the FY24 proposed rule for hospital inpatient payments, CMS is seeking healthcare stakeholder input on how to best support safety net hospitals in the Medicare program. The agency is considering ways to reimburse safety net hospitals via supplemental payments that may be better targeted than disproportionate share hospital (DSH) and uncompensated care…

Nick Hut May 22, 2023

Hospital price transparency updates include stricter enforcement, new fines and pending legislation

(Note: The last section of this article was updated May 24 where noted to reflect developments in Congress.) Enforcement of hospital price transparency regulations is becoming stricter, with CMS implementing new policies and recently fining two hospitals. Changes were anticipated after CMS leaders authored an article in February that reported 70% compliance in 2022, the…

Nick Hut May 17, 2023

Congress seems inclined to expand site-neutral payment policies in Medicare (updated)

Momentum is building in Congress toward expanding site-neutral payment in Medicare, a move that could reduce payments to hospitals by billions of dollars per year. A recent hearing, which lasted 5 ½ hours, focused on various ideas for promoting transparency and competition in healthcare. The hearing included references to 17 bills or discussion drafts, several…

Nick Hut May 12, 2023

The COVID-19 public health emergency is over: Here’s what healthcare providers should know

An era ends for the U.S. healthcare industry with the termination of the COVID-19 public health emergency (PHE) at the close of the day on Thursday, May 11. The termination means providers are losing many of the federal waivers and flexibilities that have been in place for all or most of the PHE, which took…

Nick Hut May 10, 2023

New data on No Surprises Act arbitration cases show providers are faring well amid systemic challenges

Providers are having success at challenging out-of-network payment amounts under the No Surprises Act, at least when they can get their cases through the arbitration system. CMS published an update showing that between April 15, 2022, when the independent dispute resolution (IDR) portal opened, and March 31, arbitrators issued payment determinations in 42,158 disputes. Initiating…

Nick Hut May 2, 2023

Harris Affinity Decision Support can help healthcare leaders identify meaningful areas for improvement

Improve your healthcare organization by leveraging advanced cost, performance, reimbursement and profitability data to inform and drive critical financial, operational and clinical decision-making.

HFMA May 1, 2023
googletag.cmd.push( function () { googletag.display( 'hfma-gpt-leaderboard' ); } );