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…
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…
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,…
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…
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…
Billions of dollars in lump-sum payments are coming to hospitals as a remedy for 340B-related underpayments
Hospitals that participate in the 340B Drug Pricing Program stand to receive $9 billion in aggregate lump-sum payments as compensation for underpayments from Medicare during a nearly five-year period. In a proposed rule issued July 7, CMS described how it would provide remedies following a 2022 Supreme Court ruling that the U.S. Department of Health…
Annual Conference: Houston Methodist uses AI in virtual models for critical care, patient observation and more
Artificial intelligence (AI) is driving innovation in clinical operations at the Houston Methodist hospital system, as explained during a presentation this week at HFMA’s Annual Conference. Among other virtual-care programs developed by the organization’s innovation center, Houston Methodist has incorporated a virtual ICU and virtual observation in the inpatient setting. Both programs use AI to…
Annual Conference: How Mayo Clinic establishes the mindset and processes that foster innovation
Hospitals and health systems must adapt their practices using an innovator’s mindset to keep up with the change sweeping the industry, according to a presentation this week at HFMA’s Annual Conference. “Innovation, at this point in our industry’s landscape, is pretty critical,” said Praveen Mekala, enterprise division chair with Mayo Clinic, referring to the problems…
Annual Conference: For hospitals, effective chargemaster management can bolster revenue capture
Amid the changes and challenges buffeting the hospital and health system sector, chargemaster management remains a key step in protecting revenue, according to a presentation this week at HFMA’s Annual Conference. At University of New Mexico Hospital (UNMH), a recent chargemaster initiative began with a thorough review, said Holly Cruz, senior financial analyst with University…
Annual Conference: Healthcare entrepreneur Alex Oshmyansky describes his efforts to disrupt drug pricing
Arguably no segment of the healthcare industry is more susceptible to disruption than the market for prescription drugs, as Alex Oshmyansky, MD, PhD, made clear Wednesday morning during the closing session of HFMA’s Annual Conference. Oshmyansky spoke about his personal efforts to disrupt the pharmaceutical market in his role as co-founder and CEO of Mark…