Health Plan Payment and Reimbursement

Healthcare provisions in massive legislation could improve care access but also reduce federal funding for some hospitals

In pending legislation, reductions to disproportionate share hospital payments would be used to subsidize commercial insurance for low-income residents of states that haven’t expanded Medicaid.

Nick Hut November 24, 2021

The pandemic cast a new light on mental health, and telemedicine provided a new avenue to access. How is the industry likely to view mental health and behavioral health in the future?

Dr. Ranga Krishnan of Rush University System for Health discusses the future of mental health payment and practice. He addresses how provider organizations can address workforce shortages by becoming partners in training and by changing the way they provide care to patients. He also talks about improving mental and behavioral healthcare in a value-based payment environment.

Erika Grotto November 16, 2021

Additional requirements are needed to make healthcare price transparency worthwhile, report states

Updates to price transparency regulations should address compliance and formatting and incorporate new data elements.

Nick Hut November 4, 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

Research highlights ways to save more than $250 billion per year through healthcare administrative simplification

Savings can be generated at the organizational and healthcare industry levels through steps to reduce wasteful administrative processes, study authors wrote.

Nick Hut October 22, 2021

Healthcare News of Note: Healthcare insurers owe hospitals billions of dollars in payments and are putting more patients in a bind with retroactive claim denials, says Kaiser Health News

Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: Insurers are behind in billions of dollars in payments to hospitals, the strain on clinicians and staff grows amid the pandemic, and CFO duties involve more digital activities and investor relations.

Deborah Filipek October 19, 2021

The finalized arbitration process in new surprise-billing regulations appears to favor insurers over hospitals

A new rule establishes a process for resolving payment disputes between health plans and hospitals when regulations on surprise billing begin in 2022.

Nick Hut October 8, 2021

Healthcare News of Note: U.S. will be short 3.2 million lower-wage healthcare workers within 5 years, says Mercer

Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: Shortages of lower-wage healthcare workers, nurses, physicians and mental health staff are expected, PHI security and burnout are of concern to most healthcare professionals, and the pandemic is expected to affect health insurance rates.

Deborah Filipek October 8, 2021

Site-of-care payment issues get highlighted by UnitedHealthcare and MedPAC

A new report issued by a leading health plan is the latest sign that hospitals and health systems can expect payers to ramp up implementation of site-neutral payments.

Nick Hut September 27, 2021

Recipients of COVID-19 vaccine boosters won’t have to pay anything out of pocket, CMS confirms

Medicare beneficiaries will owe nothing out of pocket for receiving an authorized booster dose, and the same applies to almost all Medicaid beneficiaries and most commercial health plan members.

Nick Hut September 26, 2021
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