Payment Reimbursement and Managed Care

News Briefs: Hospital labor costs rose by almost 40% between 2019 and early 2022

As published in hfm magazine, a monthly roundup of top news for healthcare finance professionals.

Nick Hut May 27, 2022

Medicaid expansion doesn’t appear to bolster finances or operations at critical access hospitals, study finds

Changes in operating margin, staffing ratios and quality metrics didn’t hinge on whether a critical access hospital was in a state that had expanded Medicaid.

Nick Hut December 9, 2021

Payment approaches to addressing health equity are seen in a new Medicare rule for kidney care

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.

Nick Hut October 31, 2021

Hospitals and Congress propose improvements to prior authorization processes in Medicare Advantage

The American Hospital Association says pending regulations that would affect prior authorization should be expanded to include Medicare Advantage.

Nick Hut October 22, 2021

Hospital groups express concern over earlier court ruling that could expand False Claims Act liability

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.

Nick Hut October 19, 2021

Healthcare News of Note: Average billed charge for complex COVID-19 hospitalizations is more than three times the allowed amount

HFMA October 1, 2021

Report by Medicare trustees describes a daunting payment picture for healthcare providers

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.

Nick Hut September 8, 2021

HHS can continue using Worksheet S-10 to calculate uncompensated care payments after federal court ruling

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.

Nick Hut September 7, 2021

4 keys to sustaining financial viability in the shift to value

A leading ACO in Texas has found a way to thrive despite systemic factors that can discourage value-based initiatives.

Andrew Ziskind, MD August 30, 2021

OIG report suggests Medicare pays too much to cover capital costs for new hospitals

A new federal report indicates CMS pays excessively to cover capital expenditures during the first two years of a hospital’s existence.

Nick Hut August 19, 2021
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