Key Senate committee takes a close look at healthcare waste and prices
The U.S. Senate is intent on finding ways to improve the value of healthcare, according to takeaways from a recent hearing of the Budget Committee. Although other committees and subcommittees in both chambers of Congress have held meaningful hearings about healthcare policy and costs this year, the Budget Committee’s attention to the matter is especially…
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…
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…
Senate bill would give hospitals a big break from looming Medicaid disproportionate share hospital cuts (updated)
Nov. 15 update: On Nov. 14, the House passed legislation on a bipartisan basis to keep the government funded through Jan. 19. Medicaid disproportionate share hospital payments would be guaranteed to remain at their full amount through that date, and the bill similarly maintains short-term funding for graduate medical education, community health centers and the…
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,…
Medicare’s hospital outpatient payment rate for 2024 improves marginally from the proposed rule
The final rule setting Medicare’s 2024 payment rates and policies for hospital outpatient services and ambulatory surgical centers (ASCs) contained no major surprises and little to make hospitals optimistic about the government portion of their payer mix. Here are five of the most important payment and coverage takeaways from the rule, which totals 1,672 pages…
Medicare’s final $9 billion remedy plan for 340B providers doesn’t address hospitals’ key concerns
Hospitals received final details on a $9 billion remedy payment plan for participants in the 340B Drug Pricing Program, with advocates expressing disappointment that corresponding reductions to other payments will go through as previously proposed. CMS issued a Nov. 2 final rule describing the terms of the remedy payment, which was necessitated after the Supreme…