Physician Payment and Reimbursement

A projected Medicare physician payment decrease spurs more calls to reform the system

Physician advocacy groups vehemently expressed concern about the financial consequences of CMS’s proposed rule for Medicare physician payments in 2024, intensifying a push to modify the payment system. At a time of elevated expenses in healthcare, total payments would be reduced by a projected 1.25% relative to 2023. That would follow a 2% decrease from…

Nick Hut July 24, 2023

6 actions for physician practices on signing risk-based contracts

Medical practice leaders, whether their practice is independent orpart of a health system, have different motivations for taking the plunge into risk-based contracting. Some are eager to embrace the challenge of turning better care into stronger revenue. Others just want to protect themselves from the coming reductions in fee-for-service (FFS) payment. Whatever the motivation, once…

Clifford Frank, MHSA May 26, 2023

Congress seems inclined to expand site-neutral payment policies in Medicare (updated)

Momentum is building in Congress toward expanding site-neutral payment in Medicare, a move that could reduce payments to hospitals by billions of dollars per year. A recent hearing, which lasted 5 ½ hours, focused on various ideas for promoting transparency and competition in healthcare. The hearing included references to 17 bills or discussion drafts, several…

Nick Hut May 12, 2023

New guidance for No Surprises Act arbitration looks like an improvement for providers

Responding to a recent court ruling, the U.S. Department of Health and Human Services (HHS) has updated the application of criteria for deciding No Surprises Act (NSA) independent dispute resolution (IDR) cases. Certified IDR entities (i.e., arbitrators) received guidance March 17 instructing them to more directly consider multiple factors when deciding on an out-of-network payment…

Nick Hut March 20, 2023

(Updated 2) Texas court again backs providers in No Surprises Act independent dispute resolution litigation

A physician association continues to roil the No Surprises Act’s arbitration process through successful litigation. For the second time in a year, the Texas Medical Association (TMA) prevailed in court after arguing that regulations governing the independent dispute resolution (IDR) process do not comply with legislative intent. Barring a successful appeal, the Feb. 6 ruling…

Nick Hut February 8, 2023

Seeking to phase out Medicare DSH payments, MedPAC outlines potential changes to reimbursement for safety net providers

Revamped formulas for hospitals and physicians would be designed to better target payments to providers that treat larger shares of low-income Medicare beneficiaries.

Nick Hut January 18, 2023

For the No Surprises Act arbitration process, 2023 brings a steep fee hike and continuing litigation

The No Surprises Act’s independent dispute resolution (IDR) process is about to become more expensive for healthcare stakeholders. In 2023, the nonrefundable administrative fee due from each party involved in any payment dispute that goes to arbitration will increase from $50 to $350, according to a Dec. 23 memo from CMS’s Center for Consumer Information and Insurance…

Nick Hut December 30, 2022

Massive federal spending bill alleviates reimbursement concerns for hospitals, but less so for physicians

Healthcare provider advocates applauded the inclusion of key reimbursement relief measures and other policies in a proposed federal spending bill for FY23, although physician groups expressed concern about the outlook for their constituents. With a divided Congress looking to muster the votes to pass the legislation before a self-imposed deadline of week’s end, the bill includes many…

Nick Hut December 20, 2022

CY 2023 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 2023 and other revisions to Medicare Part B policies.

HFMA December 16, 2022

CY 2023 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 2023 and other revisions to Medicare Part B policies. Part II covers the Medicare Shared Savings Program Requirements.

HFMA December 8, 2022
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