5 opportunities to unlock revenue through better compliance management in the midcycle
Hospitals and health systems are facing unprecedented challenges. Inflation, rising costs and razor-thin margins have caused many to shutter service lines, lay off non-patient-facing employees or even close entire facilities. These drastic measures might be avoidable if organizations could find opportunities to improve financial viability in other ways. Identifying and addressing noncompliance in the midcycle…
With a new rule, CMS looks to crack down on states’ Medicaid disenrollment processes
In its latest effort to stem the ongoing wave of Medicaid disenrollments, CMS issued regulations describing its authority to penalize states for disregarding federal guidelines pertaining to the end of continuous-enrollment requirements. Published Dec. 6 in an interim final rule with comment period, the regulations took effect immediately and were based on provisions passed by…
10 Keys to Restoring Trust in Healthcare
The issue of restoring consumer trust in the U.S. healthcare system encompasses a wide range of concerns. Factors in the perceived loss of trust include anxiety and confusion over costs, entrenched inequity, a glut of misinformation about vaccines and other treatments, and data and privacy breaches. To examine the problem and explore solutions, HFMA’s 16th…
The best of 2023 from HFMA’s editorial team
The HFMA editors share their favorite content from this year and provide a glimpse of what's to come in 2024.
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…
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…
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,…
Decoding revenue cycle management: Top coding questions providers ask
Quality coding is vital to a healthy revenue stream. Each member of the coding team must possess the skills and knowledge necessary to capture detailed and precise information regarding patient encounters, procedures, diagnoses and treatments. Because incorrect coding falls under the “fraud and abuse” category of the American Medical Association’s Principles of CPT Coding, penalties can…
Healthcare News of Note: Health systems benefit from hike in use of patient portals
Over the past few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals. 1. Greater patient use of online medical records and patient portals could improve patient health and benefit health systems “Improved patient outcomes” and “significant health system benefits,” are likely results of more patients in…
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,…