Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the proposed rule updating policies and payment rates to inpatient prospective payment system hospitals and long-term care hospitals.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA provides a detailed summary of the proposed rule updating the Medicare skilled nursing facility payment rates for FY 2023.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA provides a detailed summary of the proposed rule updating payment rates for inpatient psychiatric facilities prospective payment system for FY 2023.
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Blog | Contracting
HHS and CMS recently released sets of 2023 regulations that affect provider network adequacy standards in Medicare Advantage and the Affordable Care Act insurance marketplaces.
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Research & Reports | Value-Based Payment
HFMA’s Consumerism Maturity Model builds on our industry-consensus consumerism best practices to guide hospitals and health systems in their efforts to improve their patient financial experience.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the proposed rule updating policies and payment rates to inpatient prospective payment system hospitals and long-term care hospitals.
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News | Health Plan Payment and Reimbursement
The portal for payment arbitration cases taking place under the No Surprises Act is open for business but could be facing a backlog of cases.
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Executive Roundtable | Payment Trends
In this roundtable, revenue cycle leaders share their challenges, how they have enhanced payment processes through automation, and how they have identified opportunities for improvement.
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Blog | Medical Necessity
Medicare Advantage processes related to prior authorization hamper beneficiaries’ access to medically necessary care, according to a new report from the HHS Office of Inspector General.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA provides a detailed summary of the proposed rule updating the Medicare skilled nursing facility payment rates for FY 2023.
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Blog | Medicare Payment and Reimbursement
Temporary modifications to two pay-for-performance programs would ensure hospitals don’t face penalties amid the COVID-19 pandemic.
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Blog | Medicare Payment and Reimbursement
The biggest change is an effort to comply with a court ruling on weighted FTE slots, while another change affects sharable slots for certain rural hospitals.
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News | Medicare Payment and Reimbursement
The hospital industry expressed disappointment with the proposed increase for inpatient payments in FY23.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA provides a detailed summary of the proposed rule updating payment rates for inpatient psychiatric facilities prospective payment system for FY 2023.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA provides a detailed summary of the proposed rule updating payments under the Medicare inpatient rehabilitation facility prospective payment system for FY 2023.
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News | Medicare Payment and Reimbursement
CMS mostly finalized previously proposed criteria for coverage of Aduhelm, which has been promoted as the first drug to treat the underlying pathology of Alzheimer’s disease.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA provides a detailed summary of the proposed rule updating the Medicare hospice payment rates for FY 2023.
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Blog | Medicare Payment and Reimbursement
CMS has released proposed FY23 rules governing prospective payments to hospices, inpatient psychiatric facilities and inpatient rehabilitation facilities.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a summary highlighting healthcare-related proposals included in President Biden’s budget for fiscal year 2023.
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Executive Roundtable | Payment Trends
This roundtable features leaders’ insight to help entities evolve in today’s workforce to meet challenges such as regulations and digital adoption.
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News | Medicare Payment and Reimbursement
CMS shouldn’t increase Medicare payments to hospitals for the upcoming year beyond the annual update that is based on current law, according to the Medicare Payment Advisory Commission.
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News | Payment Reimbursement and Managed Care
An FY22 appropriations bill allows hospitals to remain in the 340B Drug Pricing Program if their eligibility had been adversely affected by the COVID-19 pandemic.
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News | Accountable Care Organizations
Value-based payment advocates see reason for optimism in CMS’s recent decision on the future of its Direct Contracting model.
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Blog | Medicare Payment and Reimbursement
CMS in February amended its coverage requirements for lung cancer screening and issued a code for a new COVID-19 treatment.
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News | Pricing
Recent price increases have been slower in healthcare than in the economy at large, but two healthcare economists say the long-term price trends should be addressed through regulation.
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Article | Medicaid Payment and Reimbursement
Is your hospital or healthcare system constantly seeking ways to help patients access care through Medicaid while maximizing their own reimbursement? Look no more as this sponsored survey unveils effective solutions for these challenges.
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How To | Payment Reimbursement and Managed Care
A health system’s financial sustainability depends on its being paid appropriately for the services it delivers. Yet routine payer audits can all too often result in downgrades of a health system’s billed diagnosis-related groups (DRGs), re...
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News | Value-Based Payment
Medicare’s Direct Contracting model, touted as representing the evolution of alternative payment models, could be shelved less than a year after getting started.
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News | Medicare Payment and Reimbursement
Medicare Part D and Medicare Advantage could be prime targets as Congress seeks to shore up the Hospital Insurance Trust Fund before it becomes insolvent in 2026 as projected.
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Blog | Payment Reimbursement and Managed Care
Among hospitals participating in the 340B Drug Pricing Program, a new report finds that steps taken by drug manufacturers to restrict discounts have had a significant impact.
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Blog | Medicare Payment and Reimbursement
Coverage rules stemming from Medicare national and local determinations were the most likely cause of claim denials in one Medicare Advantage plan.
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Blog | Medicare Payment and Reimbursement
Medicare will pay for use of a new drug to treat Alzheimer’s disease only for patients in approved clinical trials, CMS said in a proposed coverage determination.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the final rule relating to the Medicare physician fee schedule for CY 2022 and other revisions to Medicare Part B policies.
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News | Health Plan Payment and Reimbursement
Leading provider associations have asked a federal court to halt the incorporation of criteria that appear to favor insurers over providers in an arbitration process to determine out-of-network payment amounts.
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Blog | Medicaid Payment and Reimbursement
Changes in operating margin, staffing ratios and quality metrics didn’t hinge on whether a critical access hospital was in a state that had expanded Medicaid.
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Comment Letter | Payment Reimbursement and Managed Care
HFMA presents its comment letter to CMS on the Interim Final Rule with comment period implementing certain provisions of the No Surprises Act; Part II issued by the Department of Health and Human Services, the Department of the Treasury, th...
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News | Medicare Payment and Reimbursement
The House of Representatives is set to vote on a bill that would nullify a large share of 2022 Medicare payment cuts.
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News | Value-Based Payment
During a recent call with healthcare stakeholders, leaders with the Center for Medicare & Medicaid Innovation heard various ideas for improving value-based payment models.
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Column | Healthcare Reform
Two primary obstacles stand in the way of the nation's ability to achieve cost-effective health and healthcare delivery: the slow transition to value-based payment by physicians and the need to address social determinants of health.
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Podcast | Medicare Payment and Reimbursement
HFMA senior editor Nick Hut is joined by Rep. Suzan DelBene to talk about the Improving Seniors' Timely Access to Care Act as well as following up on the Value in Health Care Act.
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News | Medicare Payment and Reimbursement
Citing patient safety concerns among other issues, CMS formally canceled a Trump administration rule that would have required Medicare to cover breakthrough medical devices.
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News | Medicaid Payment and Reimbursement
In pending legislation, reductions to disproportionate share hospital payments would be used to subsidize commercial insurance for low-income residents of states that haven’t expanded Medicaid.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the CY 2022 OPPS and ASC payment system final rule, published by CMS.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the final rule addressing routine updates to the Medicare End-Stage Renal Disease Prospective Payment System for CY 2022.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the interim final rule revising the conditions of participation for Medicare- and Medicaid-certified providers to establish COVID-19 vaccination requirements applicable to staff.
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News | Medicare Payment and Reimbursement
CMS used the 2022 final rule for Medicare physician payments to offer accommodations on policies related to telehealth and more, but concerns loom about a large cut that's in the offing.
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News | Medicare Payment and Reimbursement
Medicare policies affecting price transparency, the inpatient-only list and more will take effect Jan. 1 after CMS published its 2022 final rule for hospital outpatient departments and ambulatory surgical centers.
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Blog | Medicare Payment and Reimbursement
Updates to a Center for Medicare & Medicaid Innovation care model for end-stage renal disease include an equity-related bonus payment and associated changes to benchmarking.
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Blog | Health Plan Payment and Reimbursement
The American Hospital Association says pending regulations that would affect prior authorization should be expanded to include Medicare Advantage.
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News | Payment Models
A forthcoming revamp of federal value-based payment models will include features designed to encourage provider participation, CMS and CMMI leaders said.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the interim final rule with comment period building on regulations issued in the July 2021 IFC to implement provisions of the No Surprises Act.
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Blog | Claims Adjudication
The groups argue that allowing FCA claims to be brought for post-termination actions would defy congressional intent and leave hospitals subject to excessive financial liability.
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News | Payment Trends
Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: Insurers are behind in billions of dollars in payments to hospitals, the strain on clinicians and staff grows amid the pandemic, and CFO duti...
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the final rule regarding the Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyo...
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News | Health Plan Payment and Reimbursement
A new rule establishes a process for resolving payment disputes between health plans and hospitals when regulations on surprise billing begin in 2022.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the proposed rule amending existing regulations to implement provisions of the No Surprises Act established to protect enrollees of health plans from surprise medical bills when they receive emergency ser...
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News | Medicare Payment and Reimbursement
The Medicare Hospital Insurance Trust Fund is on course to run out of money by 2026, and that assessment wasn’t the only concerning part for hospitals in a new government report.
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Blog | Medicare Payment and Reimbursement
A federal district court dealt hospitals a defeat in a case about uncompensated care payments, issuing a summary judgment in favor of the U.S. Department of Health and Human Services.
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How To | Accountable Care Organizations
A leading ACO in Texas has found a way to thrive despite systemic factors that can discourage value-based initiatives.
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News | Medicare Payment and Reimbursement
A roundup of the top news affecting healthcare finance professionals.
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Column | Healthcare Reform
Congress’ handling of two mammoth bills may well determine the political tone in Washington and whether there will be any room for bipartisanship for the remainder of President Joe Biden’s term.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the final rule pertaining to the fiscal year 2022 payment rates under the Medicare skilled nursing facility prospective payment system.
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Blog | Medicare Payment and Reimbursement
A new federal report indicates CMS pays excessively to cover capital expenditures during the first two years of a hospital’s existence.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the final rule updating policies and payment rates under Medicare’s IPPS for acute care hospitals and the long-term care hospital PPS for FY 2022.
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Blog | Medicare Payment and Reimbursement
Harvard researchers found evidence to suggest that hospitals with large shares of Medicare patients are at greater risk of being acquired, which can skew the market structure and lead to higher commercial prices.
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Blog | Value-Based Payment
Leaders with CMS and the Center for Medicare & Medicaid Innovation have published a rough blueprint of the future of value-based payment at the federal level.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the final rule updating the Medicare hospice payment rates, wage index, the cap amount for fiscal year (FY) 2022 and the quality reporting requirements for FY 2022.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the final rule on the Medicare inpatient rehabilitation facility prospective payment system for FY 2022.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the proposed rule updating OPPS payments that apply to outpatient services provided to Medicare beneficiaries.
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Blog | Medicare Payment and Reimbursement
The base payment increase for hospital inpatient services in FY22 will be 2.5%, according to a final rule issued by CMS.
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Blog | Contracting
The vast difference in market power between hospitals and employers leaves the latter group with little recourse in negotiations, according to a new study.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the proposed rule relating to the Medicare physician fee schedule for CY 2022 and other revisions to Medicare Part B policies.
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News | Accountable Care Organizations
Accountable care organizations stand to benefit from a new bill that would increase investment funding and make changes to federal ACO programs, several executives said.
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Blog | Medicare Payment and Reimbursement
The 2022 proposed rule for the Outpatient Prospective Payment System would reverse 2021 policies that began to phase out the inpatient-only list of procedures and expand the covered-procedures list for ambulatory surgical centers.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the interim final rules with comment period that amend and add to existing regulations to implement provisions of the No Surprises Act enacted as part of the Consolidated Appropriations Act, 2021.
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Blog | Medicare Payment and Reimbursement
Clinicians will be able to seek payment for providing mental health visits to Medicare beneficiaries via audio-only telehealth, according to newly proposed regulations from CMS.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the proposed rule regarding the Patient Protection and Affordable Care Act (ACA); Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022...
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News | Payment Models
Healthcare industry stakeholders can expect a new approach to how federal payment models are formulated, as a newly released rule for Medicare coverage of kidney care illustrates.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the CY 2022 home health prospective payment system proposed rule.
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Blog | CMS and MedPAC Guidelines and Trends
Worthwhile changes include requiring drugs to be proven clinically superior before granting them pass-through payment status, according to a new report.
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Blog | Payment Reimbursement and Managed Care
The bill would be paid for in part by extending the duration of the 2% reduction in Medicare payments and by tapping into the Provider Relief Fund.
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Comment Letter | Payment Reimbursement and Managed Care
HFMA presents its comment letter to CMS on the FY 2022 Hospital IPPS and the Long-Term Care Hospital PPS, published in the April 27, 2021, Federal Register.
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News | Payment Reimbursement and Managed Care
An under-the-radar aspect of the Supreme Court’s ruling on the Affordable Care Act involved hospital eligibility for the 340B program, an industry expert says.
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Blog | Medicare Payment and Reimbursement
Although the proposals represent a significant change, most hospitals wouldn’t be projected to experience a large impact on their payments.
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News | Healthcare Reform
Hospital advocates applauded a Supreme Court ruling June 17 that left the Affordable Care Act in place.
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Blog | CMS and MedPAC Guidelines and Trends
An extensive healthcare policy report by the Medicare Payment and Advisory Commission includes a discussion about the drawbacks of cost-based Medicare reimbursement for rural hospitals.
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News | Claims Adjudication
UHC had announced this week that it would evaluate claims starting July 1 to determine whether ED visits were for emergent or nonemergent events.
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Fact Sheet | Medicare Payment and Reimbursement
HFMA presents a summary of healthcare-related proposals included in President Biden’s budget for fiscal year 2022.
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News | Claims Adjudication
In a move strongly opposed by provider associations, UnitedHealthcare soon will start denying coverage of ED care that it deems to have been nonemergent.
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Blog | Medicare Payment and Reimbursement
A payment increase for in-home COVID-19 vaccine administration is part of a strategy to improve vaccination rates, which have slowed in recent weeks.
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Blog | MACRA
MIPS participation led to high administrative costs and a significant time drain, according to new research.
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News | Payment Models
Fee-for-service came under fire during a workshop in which prominent healthcare industry experts spoke of ways to achieve better integration of financing and care delivery.
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Blog | Payment Reimbursement and Managed Care
Indicators of coverage gaps were more likely to be seen among individuals with private insurance.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the Comprehensive Care for Joint Replacement Model Three-Year Extension final rule, published by CMS in the May 3, 2021, Federal Register.
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Article | Medicare Payment and Reimbursement
One company reviews how its SaaS solution can simplify identifying transfer DRG underpayments for hospitals.
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Column | Healthcare Reform
The Healthcare Financial Management Association and Boise State University are launching the Master’s in Population and Health Systems Management degree in August.
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Column | Healthcare Reform
The racial equity conversation needs to be had in this country, and even with hypersensitivity around the topic, HFMA’s Community DEI group is now having the conversation.
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News | Medicare Payment and Reimbursement
Recent healthcare finance and policy news included the release of the proposed rule for the FY22 Inpatient Prospective Payment System.
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News | Healthcare Reform
Leading Democrats in the House and Senate sent out a request for information to healthcare stakeholders, seeking input as they look to establish a public option for health insurance.
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Blog | CMS and MedPAC Guidelines and Trends
During her Senate confirmation hearing, Brooks-LaSure said strengthening Medicare, Medicaid and the Affordable Care Act to bolster quality and access while lowering costs will be paramount.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA provides a detailed summary of the proposed rule updating payments under the Medicare inpatient prospective payment system and the long-term care hospital prospective payment system for FY 2022.
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News | Accountable Care Organizations
Healthcare provider organizations are petitioning the Biden administration to slow recently finalized quality-related changes to the Medicare Shared Savings Program.
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Blog | Bundled Payment
Hospitals that participated in the Comprehensive Care for Joint Replacement model on a voluntary basis over the last three years will be excluded after Sept. 30.
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