Revenue Cycle

‘Concerns about access to care’ raised by OIG findings on prior authorization policies in Medicaid managed care

A year after highlighting problems with prior authorization in Medicare Advantage (MA), the HHS Office of Inspector General (OIG) has shined a spotlight on the same issue in Medicaid managed care. In the title of a new report, OIG says high rates of prior authorization denials by some Medicaid health plans “raise concerns about access…

Nick Hut August 1, 2023

How leveraging artificial intelligence in utilization management can enhance your revenue cycle

This white paper dives into how AI will help make healthcare sustainable and provide more of a focus on patient care. The goal is to decrease industry challenges and create new efforts to reduce the administrative cost of healthcare.

HFMA July 27, 2023

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

House committee approves bill requiring national provider identifiers for off-campus outpatient departments

A bill with widespread support in Congress would affect hospital billing procedures at off-campus outpatient departments if it becomes law. The House Committee on Education and the Workforce on July 12 unanimously approved legislation called the Transparency in Billing Act, which states that starting in 2024, hospital claims for items and services furnished in off-campus…

Nick Hut July 19, 2023

In proposed regulations, CMS seeks to strengthen hospital price transparency requirements

Hospital price transparency regulations are undergoing changes heading into their fourth year as CMS seeks to step up enforcement while making compliance more straightforward. As part of the 2024 proposed rule for hospital outpatient payments, CMS is adding to the requirement for hospitals to maintain a machine-readable file of their charges for services. In addition,…

Nick Hut July 17, 2023

Some of the best from HFMA’s Annual Conference in Nashville

Revisiting your investment strategy with Lisa Schneider of Russell Investments and PayMedix CEO Tom Policelli discusses why payment is so confusing for patients.

Erika Grotto July 17, 2023

Healthcare Blame Game, Live From HFMA’s Annual Conference in Nashville

The Blame Game team takes on HFMA's Annual Conference in Nashville in a discussion about what hospitals get right and wrong.

Erika Grotto July 17, 2023

Medicare outpatient payments to hospitals won’t rise considerably in 2024, according to a proposed rule

Medicare’s newly proposed outpatient payment update for 2024 is unlikely to be greeted with enthusiasm by hospitals. The update for items and services provided in the hospital outpatient or ambulatory surgical center setting would be 2.8%, mirroring the proposed change for inpatient payments. The base update would be 3%, with a statutorily required productivity adjustment…

Nick Hut July 14, 2023

10 Vital Responses to Healthcare Disruption

Disruption is reverberating throughout the healthcare industry, and it’s incumbent on legacy organizations to develop strategic responses for the benefit of their consumers, their communities and themselves. With that overarching challenge becoming ever more pressing, HFMA’s 2023 Spring Thought Leadership Retreat brought together leaders from across the industry May 4-5 in Atlanta to consider approaches…

Nick Hut July 11, 2023

4 opportunities to improve mid-cycle revenue operations

The quality of a hospital’s revenue cycle processes directly impacts the health of its bottom line. In an age of stagnant margins, hospitals should do all they can to improve revenue cycle efficiency. The mid-cycle—that critical phase between patient registration and claims submission — is a great place to start. Numerous challenges arise during this…

HFMA July 10, 2023
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