HHS: Insurers won’t be penalized if they don’t update their No Surprises Act qualifying payment amounts as required
Providers may not immediately benefit from a favorable court ruling that affects the methodology for determining the qualifying payment amount (QPA) under the No Surprises Act. The U.S. Department of Health and Human Services (HHS) issued guidance Oct. 6 that says the Biden administration will not enforce the court decision until at least May 1.…
Insights on population health management challenges through the eyes of C-suite leaders
Population health management is at a crossroads, and one key to ensuring its viability is to bolster stakeholder trust in the potential of value-based payment (VBP) models. That was a key takeaway from healthcare executives who took part in a September panel discussion at the 23rd annual Population Health Colloquium, hosted by the Jefferson College…
Medicaid DSH payment cut barely averted as House, Senate pass short-term federal funding
Hospitals received a last-day reprieve from substantial cuts to Medicaid disproportionate share hospital (DSH) payments, with House leaders reversing course Sept. 30 and ushering through a six-week government funding package. Language in the bill ensures a four-year, $32 billion Medicaid DSH cut will not take effect before Nov. 17. Most importantly, the bill bought time…
Update: Medicaid DSH payment cut averted as House, Senate pass short-term federal funding
Note: The headline and lead section of this article were updated Oct. 1 with news of a six-week government funding extension that delays the Medicaid DSH cuts and pays for other healthcare programs. The article originally was published Sept. 28 under the headline, “An $8 billion Medicaid DSH cut is closer to happening as a…
Risky business: What every CFO should know before taking on risk
As a health system leader, how can you ensure your organization is making the right moves to take on risk in an evolving landscape for payment? Check out a handful of key capabilities to focus on in this article.
PFC USA’s partnership approach ensures healthcare clients tackle regulatory and patient satisfaction issues
Review some tips from a company with 6.5 years of hands-on experience in helping its healthcare clients handle concerns in healthcare such as workforce shortages and a volatile regulatory environment.
HFMA Comments on CY 2024 OPPS/ASC Proposed Rule
HFMA presents its comment letter to CMS on the CY 2024 OPPS/ASC Proposed Rule.
CMS pressures states to restore Medicaid coverage for some beneficiaries who have been disenrolled
CMS says a recent edict to state Medicaid programs has partially stanched the ongoing wave of disenrollments in the program, with about 500,000 beneficiaries set to regain coverage they had lost and “many” others protected from disenrollment going forward. As described in a Sept. 21 summary, 29 states plus Washington, D.C., have acknowledged a systemic…
HHS sets new administrative fee to be paid by parties in No Surprises Act independent dispute resolution cases
Oct. 6 update: The lead section of this article was updated where noted with news about the arbitration portal. The administrative fee for taking out-of-network payment disputes to arbitration under the No Surprises Act in 2024 would be significantly lower than it was for much of 2023, but triple the current rate, according to proposed…
American providers remain in reimbursement limbo during IDR failure
HFMA and its member healthcare providers are growing more concerned over the extended delay of reimbursement from group health plans subject to the unresolved No Surprises Act IDR regulations and guidance. HFMA members continue to report that numerous health plans persist in determining very low rates for calculating the Quality Performance Assessment (QPA) they are…