News Briefs: Hospitals foresee adverse impacts from the FY24 inpatient payment rule
The FY24 final rule for Medicare inpatient payments didn’t bring hospitals the type of rate update they had sought, and for some organizations, a bigger concern is changes to uncompensated care (UC) payments. The regulations, which take effect Oct. 1, establish a 3.1% increase in operating payment rates, on average, for hospitals that meet quality-reporting…
Prices of drugs for diabetes, heart failure and more will be up for negotiation in Medicare next year
The U.S. Department of Health and Human Services (HHS) on Tuesday announced the first 10 Medicare Part D drugs that will be subject to price negotiations, the headlining healthcare-related provision of the Inflation Reduction Act. Signed in August 2022, the law gave Medicare authority to negotiate with drug manufacturers over the prices of selected drugs.…
Leverage healthcare price transparency data to promote financial sustainability
Healthcare organizations are encouraged to review strategies and how to collaborate with payers, among other insights in this article, in order to grow healthcare consumer trust, engagement and retention.
Healthcare News of Note: Latino, Black and Asian people ‘significantly more likely’ to enroll in Medicare Advantage
Over the past few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals. 1. MA and FFS Medicare program enrollees report similar care quality, but demographic differences are evident Although quality of care reported “is similar” among enrollees in Medicare Advantage (MA) and fee-for-service (FFS) Medicare, demographic…
Key questions for providers after more than 2 years of the price transparency rule
Evidence amassed from over two years of experience with compliance reinforces why providers need to focus on chargemaster prices and self-pay discount policies — and how they can benefit from analyzing trends in consumers’ price searches.
No Surprises Act litigation update: QPA methodology deemed illegal as Texas Medical Association wins in court again (updated)
Note: The first section of this article has been updated with the latest news on the status of the arbitration portal. The fourth victory in four cases brought by the Texas Medical Association (TMA) has implications for how insurers calculate the qualifying payment amount (QPA) used to arbitrate out-of-network payment sums under the No Surprises…
FY 2024 Skilled Nursing Facilities PPS Final Rule Summary
HFMA presents a detailed summary of the final rule updating the Medicare skilled nursing facility (SNF) payment rates for FY 2024.
Children’s hospitals swim against the tide to improve the health of their patients and communities
As the nation’s pediatric hospitals strive to keep kids healthy, they face obstacles that reflect the difficulty of enacting structural changes in care delivery. Even pediatric hospitals that are eager to engage in value-based payment (VBP) models can have a hard time establishing the type of network that allows them to affect the holistic health…
Healthcare News of Note: DOL sues UnitedHealth Group subsidiary for claim denials
The U.S. Department of Labor recently sued UMR Inc., the nation’s largest third-party healthcare claims administrator, for denials involving emergency department services and urinary drug screening. Twenty-two of U.S. News & World Report’s Best Hospitals also made the publication’s honor roll, which recognizes hospitals for demonstrating exceptional breadth of excellence across clinical specialties. Substantial resources…
Navigating Medicare’s 2024 inpatient payment rule
On Aug. 1, 2023, CMS published its final rule for federal FY24 inpatient prospective payment system (IPPS). Undoubtedly, navigating such complexity in a healthcare rule can be quite challenging. The purpose of this blog post is to provide some much-needed clarity regarding the new rule, enabling healthcare finance leaders to direct their attention towards the…