Navigating Medicare’s 2024 inpatient payment rule
On Aug. 1, 2023, CMS published its final rule for federal FY24 inpatient prospective payment system (IPPS). Undoubtedly, navigating such complexity in a healthcare rule can be quite challenging. The purpose of this blog post is to provide some much-needed clarity regarding the new rule, enabling healthcare finance leaders to direct their attention towards the…
Regulators seek feedback about medical credit cards as potential restrictions loom
A federal request for information signals heightened scrutiny on the issuance of credit cards in healthcare settings. The Consumer Financial Protection Bureau, Department of Health and Human Services and Department of the Treasury sent out an RFI in July to gain stakeholder feedback on whether the widespread availability of medical payment products such as credit…
Congress puts the community benefit standard for nonprofit hospitals under the microscope
The criteria that establish hospitals’ tax-exempt status are coming under closer scrutiny, with a bipartisan quartet of senators asking the IRS to ramp up its oversight of compliance with the community benefit standard. Sens. Bill Cassidy, MD (R-La.), Charles Grassley (R-Iowa), Raphael Warnock (D-Ga.) and Elizabeth Warren (D-Mass.) sent an Aug. 7 letter to the…
Healthcare News of Note: 10 drugs account for a large share of Medicare Part D spending
In total, Part D gross spending rose from $166 billion in 2018 to $216 billion in 2021. In 2023, customer personal identifiable information costs organizations $183 per record and employee PII costs $181 per record. Average length across all clinical notes increased 8.1%, from 4,628 characters in May 2020 to 5,002 characters in April 2023. …
FTC and HHS’s Office for Civil Rights put healthcare stakeholders on notice about the use of tracking technology
Federal regulators plan to more rigorously monitor whether tracking technologies on provider websites are impermissibly disclosing consumers’ protected health information (PHI) to third parties in violation of HIPAA. The Federal Trade Commission (FTC) and the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services last month sent a letter to…
Cyberattack leaves hospitals scrambling in several states
A recent attack was the latest to illustrate the potential of cybercriminals to cause havoc across an interstate health system. The Los Angeles-based Prospect Medical Holdings system incurred a ransomware attack Aug. 3 that temporarily required some patients to be diverted from emergency departments and relegated hospitals to using paper records and incorporating other downtime…
Medicare’s proposed remedy for 340B-acquired drug underpayments: Addressing only half at best?
On July 7, 2023, CMS released a proposed rule, identified as CMS-1793-P, which outlines the agency’s intended actions to address the adjustment of Medicare payment rates for drugs acquired under the 340B Drug Pricing Program. This proposed rule pertains to the period spanning from calendar year 2018 through Sept. 27, 2022. The necessity for this remedy…
The No Surprises Act arbitration portal is temporarily closed for business after providers’ latest legal victory (updated)
Note: See the bottom of this article for the latest updates. The U.S. Departments of Health and Human Services (HHS), Labor and Treasury on Friday temporarily shut down the system for settling disputes over out-of-network payment amounts under the No Surprises Act. A day earlier, a federal judge gave the Texas Medical Association (TMA) the…
5 things to know about Medicare’s FY24 final rule for inpatient payments as hospitals foresee adverse impacts
The FY24 final rule for Medicare inpatient payments didn’t bring hospitals the type of rate update they sought, and for some organizations a bigger concern is changes to uncompensated care (UC) payments and disproportionate share hospital (DSH) payments. Here are five big points about the regulations, which take effect Oct. 1 and also cover Medicare…
‘Concerns about access to care’ raised by OIG findings on prior authorization policies in Medicaid managed care
A year after highlighting problems with prior authorization in Medicare Advantage (MA), the HHS Office of Inspector General (OIG) has shined a spotlight on the same issue in Medicaid managed care. In the title of a new report, OIG says high rates of prior authorization denials by some Medicaid health plans “raise concerns about access…