Payment Reimbursement and Managed Care

Prior authorization in Medicare Advantage remains in the policy spotlight as 2024 regulations take effect

Healthcare policymakers and stakeholders continue to mull the need for guardrails to ensure optimal customer service among Medicare Advantage (MA) health plans. The American Hospital Association wrote a Nov. 20 letter to CMS stating that MA plans are looking to skirt policies designed to ensure straightforward coverage of essential healthcare services. These policies, finalized earlier…

Nick Hut December 1, 2023

CY 2024 Physician Fee Schedule Final Rule Summary Part II – Medicare Shared Savings Program Requirements

HFMA presents part II of three detailed summaries of the final rule relating to the Medicare physician fee schedule for CY 2024 and other revisions to Medicare Part B policies. Part II covers the Medicare Shared Savings Program Requirements.

HFMA December 1, 2023

CY 2024 Physician Fee Schedule Final Rule Summary – Part I

HFMA presents part I of three detailed summaries of the final rule relating to the Medicare physician fee schedule for CY 2024 and other revisions to Medicare Part B policies.

HFMA December 1, 2023

Congress doesn’t seem to be mulling a fix for the 2024 Medicare physician payment cut

Congress has mitigated a scheduled Medicare payment cut for physicians going into each of the last three years, but relief does not appear to be on the way for a fourth year running. Medicare’s 2024 final rule for physician payments includes a $1.15 decrease to the conversion factor, amounting to a reduction of more than…

Nick Hut November 27, 2023

Payer scorecards hold promise for promoting an enhanced payer-provider equilibrium

The U.S. healthcare system is fraught with inherent complexities in how providers receive payment for the services they deliver. And those complexities include conflicting methodologies that too often breed contentiousness between payers and providers around how, when and whether services will be reimbursed. Payer scorecards offer an effective solution for mitigating these tendencies. While they…

Eric C. Reese, PhD November 22, 2023

Remedy for the 340B-Acquired Drug Payment Policy Final Rule Summary

HFMA presents a detailed summary of the final rule released by CMS describing its actions to craft a remedy relating to the adjustment of Medicare payment rates for drugs acquired under the 340B Program from calendar year 2018 through September 27, 2022.

HFMA November 20, 2023

Proposed rule sets Medicare penalties for providers that commit information-blocking infractions

Hospitals and other healthcare providers would face penalties for knowingly engaging in information blocking, with the sanctions affecting their Medicare reimbursement, according to a proposed rule from the U.S. Department of Health and Human Services (HHS) and CMS. Published at the beginning of November, the rule implements some terms of the 21st Century Cures Act,…

Nick Hut November 17, 2023

Senate bill would give hospitals a big break from looming Medicaid disproportionate share hospital cuts (updated)

Nov. 15 update: On Nov. 14, the House passed legislation on a bipartisan basis to keep the government funded through Jan. 19. Medicaid disproportionate share hospital payments would be guaranteed to remain at their full amount through that date, and the bill similarly maintains short-term funding for graduate medical education, community health centers and the…

Nick Hut November 13, 2023

CMS finalizes enhanced hospital price transparency requirements for 2024

Hospital price transparency mandates are set to become more stringent in the coming year as CMS seeks to strengthen regulations that have been on the books since 2021. Medicare’s 2024 final rule for hospital outpatient payments includes updates to the price transparency rules. Hospitals will need to post charge information using a more precise template,…

Nick Hut November 9, 2023

CMS’s 340B-acquired drug payment policy final rule is here

The 340B Drug Pricing Program final rule was published[DF1] [SS2] [SS3]  in the Federal Register Nov. 8, 2023, after CMS released details of it (CMS-1793-F) on Nov. 2, 2023. The rule details the agency’s actions, and in some cases non-actions, to adjust Medicare payment rates for drugs acquired under the 340B program from calendar year 2018 through Sept.…

Shawn Stack November 8, 2023
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