Physician Payment and Reimbursement

Medicare’s proposed 2025 rule for physician payments would add to the financial strain facing practices

Medicare’s proposed update to physician payments for 2025 left advocates saying practices will have an increasingly difficult time making ends meet. CMS’s newly proposed rule states that payments are set to be reduced by 2.8% from 2024, based on the change to the conversion factor. The agency explained that it is obligated to implement the…

Nick Hut July 18, 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

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

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

In Congress, it’s status quo for Medicaid DSH payments and the Medicare physician fee schedule

Yet another short-term federal funding measure from Congress included yet another brief extension of full funding for Medicaid disproportionate share hospital (DSH) payments. With funding for much of the federal government set to expire Jan. 19, Congress agreed on a continuing resolution that keeps all agencies fully operational until March. Medicaid DSH payments are guaranteed…

Nick Hut January 22, 2024

No Surprises Act end-of-year update: A new administrative fee is set, and the arbitration portal is fully functional

Bringing out-of-network payment disputes to arbitration under the No Surprises Act in 2024 will be less expensive than previously described. In a final rule, the U.S. Departments of Health and Human Services (HHS), Labor and Treasury set the administrative fee for using the independent dispute resolution (IDR) portal at $115 per case, effective 30 days…

Nick Hut December 20, 2023

2024 Physician Fee Schedule Specialty Impact Tables – Updated

HFMA presents an updated specialty impact tables based on the 2024 Medicare Physician Fee Schedule final rule.

HFMA December 19, 2023

Comparison of 2024 Physician Fee Schedule Final Payment Rates to October 2023 Payment Rates – Updated

HFMA presents an updated spreadsheet comparing the 2024 physician fee schedule payment rates to the 2023 payment rates.

HFMA December 19, 2023

House passes bill to codify healthcare price transparency, expand site-neutral payment

The hospital industry saw reason for both relief and disappointment this week after a bill designed to promote price transparency took a major step toward becoming law. The House on Dec. 11 passed H.R. 5378, also known as the Lower Costs, More Transparency Act, by a 320-71 vote. Along with cementing price transparency as the…

Nick Hut December 12, 2023

CY 2024 Physician Fee Schedule Final Rule Summary Part III – Quality Payment Program Updates

HFMA presents part III 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 III covers the updates to the Quality Payment Program.

HFMA December 4, 2023
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