New regulations are projected to bring providers a measure of relief from prior authorization headaches
Hospitals and other healthcare providers hailed a newly published final rule designed to improve prior authorization and the electronic exchange of health information. The Interoperability and Prior Authorization rule sets requirements for Medicare Advantage (MA) health plans, state Medicaid and CHIP programs, and Medicaid managed care organizations, all of which starting in 2026 must send…
Medicare beneficiaries would have new options for appealing their hospital patient status under a proposed rule from CMS
A proposed rule from CMS would affect the appeals process for some patients whose status is reclassified from inpatient to outpatient observation during a hospital stay. After a 2020 court ruling that was upheld at the appellate level in 2022, the U.S. Department of Health and Human Services and CMS were obligated to create additional…
The state of U.S. primary care: How new ways of thinking can spur meaningful improvement
As healthcare stakeholders consider ways to fortify the nation’s primary care system, industry leaders recommend emphasizing several strategies and components — and not waiting to act. “We’re close to midnight in many respects in thinking about how to urgently preserve and expand primary care in America,” Susan Dentzer, president and CEO of America’s Physician Groups…
Recent updates and emerging best practices for ACOs in the Medicare Shared Savings Program
Going into the 12th year since it brought accountable care into the healthcare lexicon, the Medicare Shared Savings Program (MSSP) continues to evolve, with CMS making changes and participants fine-tuning best practices. Starting with 220 accountable care organizations (ACOs) in 2012-13, the MSSP grew to 561 in 2018. However, the number has been below 500…
Healthcare News of Note: 4 in 5 healthcare leaders received credible job offers in early 2023; what kept most of them from jumping ship?
Over the past few weeks, I have found these recent industry news stories that should be of interest to healthcare finance professionals. 1. Culture and compensation were the top reasons why most healthcare leaders did not of accept ‘viable’ job offers in early 2023 Although four of five healthcare leaders received viable job offers in…
Experts forecast a busy year for healthcare M&A even with changes to regulatory oversight
A more exacting system for regulatory reviews is a factor in the short-term outlook for healthcare mergers and acquisitions. New M&A guidelines from the Federal Trade Commission (FTC) and the U.S. Department of Justice (DOJ) add a wrinkle to the process of consummating deals, especially in the short term as the parties adjust to the…
2024 outlook: Hospitals can expect a steadier year financially, but key questions loom
Although the past year brought more stability for the not-for-profit hospital sector, analysts foresee 2024 as a pivotal period in determining the viability of individual organizations. Fitch Ratings continues to describe the sector’s outlook as “Deteriorating.” In a year-end report, the credit-rating agency said downgrades of hospitals and health systems in 2023 had outpaced upgrades…
No Surprises Act end-of-year update: A new administrative fee is set, and the arbitration portal is fully functional
Bringing out-of-network payment disputes to arbitration under the No Surprises Act in 2024 will be less expensive than previously described. In a final rule, the U.S. Departments of Health and Human Services (HHS), Labor and Treasury set the administrative fee for using the independent dispute resolution (IDR) portal at $115 per case, effective 30 days…
Healthcare News of Note: What topics did healthcare finance professionals find of most interest in 2023?
Workforce issues drew the most engagement in HFMA’s Healthcare News of Note blog Three of the 10 most-read Healthcare News of Note blog posts of 2023 were workforce-related, making it the No. 1 topic sparking blog readers’ interest. Those stories were: 7 stories round out the top 10 of 2023 Additional topics that piqued reader…
HFMA strategy session highlights challenges and opportunities for healthcare finance leaders: payer relations, supply costs, AI and more
The legacy healthcare provider’s position in the industry could grow tenuous if leaders don’t respond boldly and strategically to ongoing trends, according to insights recently presented to HFMA leaders. “We’re at a crossroads right now,” Ashraf Shehata, principal and U.S. national sector leader for healthcare and life sciences with KPMG, said in November during a…