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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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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Blog | Medicare Payment and Reimbursement
An FY22 requirement for hospitals to disclose privately negotiated MA rates on their Medicare cost reports has been rescinded in the proposed rule for the Inpatient Prospective Payment System.
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Article | Medicare Payment and Reimbursement
Medicare disproportionate share hospital payments payments help serve low-income populations, but comes with a set of challenges such as identifying eligible patients. See one company’s solution by leveraging unique processing and data inte...
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Blog | Medicare Payment and Reimbursement
CMS’s FY22 proposed rule for the Inpatient Prospective Payment System includes a 2.8% payment increase for general acute care hospitals.
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News | Medicare Payment and Reimbursement
News briefs for May include recoupment of Medicare advance payments, a potential issue with hospitals' 340B eligibility, and more.
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News | Value-Based Payment
The director of the Center for Medicare & Medicaid Innovation is conducting a “strategic refresh” of the agency to consider how the healthcare industry’s transition to value can be improved.
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Blog | Medicare Payment and Reimbursement
Medicare no longer will pay healthcare providers for administering the COVID-19 treatment bamlanivimab now that the FDA has revoked the Emergency Use Authorization for treatments in which the drug is administered alone.
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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 2022.
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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 2022.
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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 2022.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the FY 2022 inpatient psychiatric facilities prospective payment system proposed rule, published by CMS.
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Blog | Value-Based Payment
The Center for Medicare & Medicaid Innovation announced the 53 entities that have been accepted as participants in the new Global and Professional Direct Contracting model.
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Article | Value-Based Payment
One company uses its cloud-native financial accounting system to provide acute, ambulatory and post-acute organizations with data to solve their most complex challenges, focus on strategic initiatives, increase efficiency and drive growth.
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News | Medicare Payment and Reimbursement
The $1.9 trillion American Rescue Plan, which was signed into law March 11, could lead to a significant reduction in Medicare revenues if Congress does not act.
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Executive Perspective | Value-Based Payment
Three health system executives discuss the key factors that have contributed to their organizations’ long-standing success with value-based payment models.
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Blog | Pricing
HHS has postponed a Trump administration regulation that would require federally qualified health centers to make certain drugs more affordable for low-income patients and will consider whether to withdraw the rule altogether.
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News | Medicare Payment and Reimbursement
Hospitals and health systems urgently need Congress to extend the freeze on the 2% Medicare payment sequester, industry leaders said.
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Blog | Medicaid Payment and Reimbursement
Disproportionate Share Hospital payments don’t always align with key metrics such as uninsured rates and uncompensated care costs, a new policy report finds.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the health provisions in The American Rescue Plan Act of 2021.
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News | Medicare Payment and Reimbursement
The Medicare Hospital Insurance Trust Fund, used to pay for Part A hospital care, is on track to become insolvent as soon as 2024. Insolvency could lead to delays in payments to providers and adversely affect patient access.
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Blog | Pricing
The American Hospital Association had a negative reaction to study findings showing that regulation of hospital prices would be the most effective way to reduce prices paid by commercial insurers.
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Blog | Medicare Payment and Reimbursement
The American Hospital Association and other hospital groups are challenging 2020 appeals court decisions that allow HHS to continue slashing payments to 340B hospitals and to off-campus provider-based departments.
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News | Healthcare Reform
A panel of experts explored how to make healthcare more effective both generally and for underserved demographics specifically.
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Blog | Healthcare Reform
An executive order by President Joe Biden directed HHS to open the Affordable Care Act marketplaces for three months starting in mid-February.
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News | CMS and MedPAC Guidelines and Trends
The January meeting of the Medicare Payment Advisory Commission included policy discussions about some of the most pressing issues in healthcare, including coverage of telehealth services.
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News | Medicare Payment and Reimbursement
News of Note for healthcare finance professionals is a roundup of articles from the past weeks, including, the Biden administration ordering a review of recently finalized regulations across government agencies, leaving the fate of several ...
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Column | Healthcare Reform
The new Biden administration could achieve either of two scenarios in the realm of health policy: One would involve bold changes to health policy, whereas the other, which is more likely, would involve less-ambitious reforms that can garner...
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News | Managed Care
Healthcare News of Note for healthcare finance professionals is a roundup of articles from the past week, including why payers are pushing back on the prior-authorization rule and information on HHS funding to support the nation's response ...
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Comment Letter | Payment Reimbursement and Managed Care
HFMA presents its December 18, 2020, comment letter to CMS regarding the Most Favored Nation (MFN) Model Interim Final Rule.
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Blog | Value-Based Payment
While the MA Stars Rating program is a bonus program where plans can earn additional revenue for achieving high scores, quality in the Geographic Direct Contracting program is treated more like a penalty, says HFMA's Chad Mulvany.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the CY 2021 physician fee schedule final rule and interim final rules, except the Quality Payment Program.
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Blog | Payment Models
HFMA’s Chad Mulvany says some state governments, like Connecticut, have high enough volumes that COVID-19 may accelerate their adoption of value-based payment models.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a detailed summary of the CY 2021 OPPS and ASC payment system final rule, published by CMS.
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News | Value-Based Payment
The Geographic Direct Contracting model will test full-risk arrangements for healthcare entities serving thousands of Medicare beneficiaries within defined geographic areas.
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News | Medicare Payment and Reimbursement
The final rule for the CY21 Medicare Outpatient Prospective Payment System will phase out the inpatient-only list but won’t implement steeper 340B cuts.
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News | Value-Based Payment
Final rules modifying enforcement of the Stark Law and the Anti-Kickback Statute aim to remove barriers to participation in value-based payment models.
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Fact Sheet | Payment Reimbursement and Managed Care
HFMA presents a summary highlighting the major provisions of the interim final rule with comment period creating a Most Favored Nation Model for Part B drugs.
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