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…
Understanding the true cost to collect requires focusing on high-level KPIs
Revenue cycle management leaders from around the country share their perspectives on defining and maintaining a high-performance revenue cycle and the challenges they face in working to enhance revenue cycle management.
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…
In response to a congressional RFI, provider advocates give input on ways to bolster rural healthcare
Hospital and physician groups were among the respondents to a request by a key congressional committee for information on improving rural healthcare. In an RFI issued in September, the House Ways and Means Committee sought policy solutions for augmenting access to — and the quality of — healthcare in relatively remote areas. “The committee will…
‘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…
How leveraging artificial intelligence in utilization management can enhance your revenue cycle
This white paper dives into how AI will help make healthcare sustainable and provide more of a focus on patient care. The goal is to decrease industry challenges and create new efforts to reduce the administrative cost of healthcare.
International member spotlight: Deepa Gigeesh aspires to reach new career heights
HFMA recently spoke with Deepa Gigeesh, revenue recovery officer at Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE. SSMC is HFMA’s first international Enterprise Solutions member, which allows SSMC’s healthcare finance staff to access HFMA tools, resources and education that align with their career development and business goals. Please describe your current position and job…
Denials Management Research Report
HFMA, with sponsorship from Waystar, surveyed 415 healthcare finance and revenue cycle executives to understand how denials are affecting their revenue cycle operations.
Survey reveals 5 opportunities to tackle denial prevention and management
In this survey, responses found when organizations devote greater resources to denial management than to denial prevention, their rate of first-pass denials is higher: 13.6% versus 10.9%.
Report quantifies the financial impact of certain health plan business practices on providers
As hospitals seek to regain their financial footing coming out of the pandemic, they may find themselves stymied by commercial payer policies, according to a new report. “It’s true that commercial payers might generate more net revenue than public payers on a per-case basis,” Crowe states in a report it recently published. “But at what…