Payment Reimbursement and Managed Care

Medicaid DSH Third-Party Payer Final Rule Summary

HFMA presents a detailed summary of the final rule issued by CMS addressing legislative changes to the hospital- specific limit on Medicaid disproportionate share hospital payments that took effect on October 1, 2021, as a result of the Consolidated Appropriations Act 2021.

HFMA March 11, 2024

Federal funding legislation would address Medicaid DSH cuts, physician payments and more

March 8 update The Senate passed the appropriations bill by a 75-22 vote, getting it to the White House for President Joe Biden to sign hours before funding for some federal departments would have expired and a big cut to Medicaid disproportionate share hospital payments would have begun. Attention now turns to HHS and other…

Nick Hut March 6, 2024

Continued 340B eligibility is at risk for hundreds of hospitals thanks to pandemic-related factors

Hospitals that rely on savings from the 340B Drug Pricing Program should examine the possibility that they will soon be rendered ineligible. Several factors are having an industrywide impact on the disproportionate share hospital adjustment percentage, and if that tally drops below a certain threshold on a hospital’s Medicare cost report, the hospital cannot receive…

Nick Hut March 1, 2024

The importance of digital transformation in a fraudulent environment

In this recently conducted survey, more than 85% of responding hospital financial executives said they are somewhat concerned (65.96%) or very concerned (19.15%) about potential AI-influenced fraud, including account takeovers and eventually payment fraud.

HFMA February 29, 2024

How digital patient engagement solutions can help healthcare organizations improve their existing revenue cycle

This roundtable features various healthcare professionals who breakdown what digital patient engagement solutions are being implemented and how this not only empowers patients, but also helps organizations looking to improve their existing revenue cycle.

HFMA February 29, 2024

Healthcare Finance Trends for 2024

Download this eBook to see details of the 10 financial trends that will shape 2024 for hospitals and health systems across the country.

HFMA February 28, 2024

Healthcare Blame Game: Bloomberg Philanthropies puts $250 million into educating new healthcare workers while Patient Rights Advocate spends on spreading misinformation

Chad Mulvany, vice president of federal policy for the California Hospital Association and former HFMA policy director, discusses Bloomberg Philanthropies $250 million investment in the future healthcare workforce, as well as what will actually move the needle on price transparency.

Erika Grotto February 26, 2024

Cyberattack on Change Healthcare brings turmoil to healthcare operations nationwide

Resources A list of payer contacts for providers to inquire about advance payments An FAQ on Medicare accelerated and advance payments Recommendations and resources for HFMA members Link to UnitedHealth Group and Optum incident pages May 21 updates New numbers from Strata’s database describe the payment hit incurred by hospitals during approximately the first five…

Nick Hut February 25, 2024

New rule on Medicaid DSH payments will impose stricter limits on many hospitals

Numerous hospitals that receive Medicaid disproportionate share hospital (DSH) payments face a tighter cap on their payment amounts after the Feb. 23 publication of a CMS final rule. The regulations were spawned by 2020 year-end legislation that made changes to the DSH hospital-specific limit (HSL), including with respect to how third-party payments factor into the…

Nick Hut February 23, 2024

New data shows providers continuing to win most No Surprises Act independent dispute resolution cases

Providers won a large majority of disputes initiated during the first half of 2023 through the No Surprises Act’s arbitration portal for adjudicating out-of-network payments, according to newly published data. HHS and the U.S. Departments of Labor and Treasury released public-use files (available to download here under “2023 Reporting Year”) showing the outcome of every…

Nick Hut February 21, 2024
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