Reimbursement

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…

Nick Hut April 16, 2024

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,…

Nick Hut April 12, 2024

Hospital advocates bemoan the small Medicare payment increase proposed for FY25

The payment increase described in Medicare’s FY25 proposed rule for acute care and long-term care hospitals falls well short of what hospitals need to keep up with costs, advocates say. The payment rate would rise by 2.6% for hospitals that fulfill quality-reporting requirements and meet the criteria to be designated as meaningful users of electronic…

Nick Hut April 11, 2024

Insurers see reasons for concern as CMS keeps the Medicare Advantage purse strings tight for 2025

Medicare Advantage (MA) faces the prospect of constrained revenue and payments for participating stakeholders after CMS finalized what amounts to a small decrease in the 2025 payment rate. Average revenue for MA plans is projected to increase by 3.7%, or more than $16 billion — but that’s primarily because of a prospective increase in the…

Nick Hut April 4, 2024

BESLER provides thorough Transfer DRG revenue recovery services

Hospitals require clear and simple paths through the challenges posed by changing regulations so they can spend more time and dollars focusing on enhancing patient care.

HFMA April 1, 2024

How providers can optimize payer contract negotiations

Negotiating payer contracts can be both challenging and frustrating. Payers have significant leverage at the bargaining table, enhanced by payer consolidations and the emergence of dominant local, regional and national plans. But by adopting a transparent data-driven strategy in negotiations with a payer, a provider organization can create an opportunity for building a strong partnership…

Scott G. Ellsworth, MBA March 29, 2024

The FY24 HHS budget covers key programs for rural hospitals while tightening spending in some areas

The newly passed budget covering HHS during the remainder of FY24 contains notable provisions for healthcare providers. The roughly $117 billion departmental budget for the next six months was set in an appropriations bill that was passed by Congress and signed by President Joe Biden within hours of the March 22 expiration of funding for…

Nick Hut March 25, 2024

Highlights of the Administration’s FY 2025 Budget

HFMA presents a summary highlighting healthcare-related proposals included in the President’s Budget for fiscal year 2025, based on materials released by the Biden Administration on March 11, 2024.

HFMA March 22, 2024

Hospitals warrant an extra boost in their Medicare payment rate next year, MedPAC says

Hospitals will get a more favorable Medicare payment increase in FY25 if Congress follows the recommendations of the Medicare Payment Advisory Commission (MedPAC). In its semiannual report to Congress, MedPAC recommended a 1.5% bump on top of what otherwise would be provided according to statute. That would mean an estimated increase of about 4.5% for…

Nick Hut March 22, 2024

Improve Patient Refunds With A Simplified B2C Payments Solution

Download this eBook to get insights into patient refunds and a solution to streamline the process for the provider while improving the patient financial experience.

HFMA March 20, 2024
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