Health Plan Payment and Reimbursement

FY22 rule for the Inpatient Prospective Payment System finalizes a payment increase and key policy updates

The base payment increase for hospital inpatient services in FY22 will be 2.5%, according to a final rule issued by CMS.

Nick Hut August 3, 2021

A closer look at the new surprise billing regulations: How cost sharing will be calculated

The qualifying payment amount that establishes a patient's cost sharing for out-of-network care also is intended to factor into negotiations between providers and health plans regarding payment.

Nick Hut July 15, 2021

Healthcare News of Note: Few consumers are using publicly posted negotiated prices to comparison shop for healthcare services

Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: Little use of price transparency information to comparison shop for healthcare services, the nursing shortage being felt throughout the U.S., and cash payers being charged more for the same services than patients with insurance.

Deborah Filipek July 9, 2021

A closer look at the new surprise billing regulations: The impact on balance billing

New regulations on surprise billing will affect hospital billing processes starting in 2022.

Nick Hut July 9, 2021

Government agencies issue the first set of regulations restricting surprise billing

In a development that many healthcare stakeholders have awaited for months, four federal agencies on Thursday, July 1 released new regulations prohibiting surprise billing in many scenarios.

Nick Hut July 2, 2021

Supreme Court leaves Affordable Care Act intact, but stakeholders say healthcare reform still has a ways to go

Hospital advocates applauded a Supreme Court ruling June 17 that left the Affordable Care Act in place.

Nick Hut June 18, 2021

HHS sends letter to providers, insurers reinforcing requirements for COVID-19 vaccination and testing to be free for all recipients

Xavier Becerra, secretary of HHS, issued a letter emphasizing that out-of-pocket fees for COVID-19-related services are prohibited.

Nick Hut June 13, 2021

UnitedHealthcare reverses course on new approach to emergency department claims, but perhaps only temporarily

UHC had announced this week that it would evaluate claims starting July 1 to determine whether ED visits were for emergent or nonemergent events.

Nick Hut June 10, 2021

Looming UnitedHealthcare policy on coverage of emergency department care draws opposition from hospitals, physicians

In a move strongly opposed by provider associations, UnitedHealthcare soon will start denying coverage of ED care that it deems to have been nonemergent.

Nick Hut June 10, 2021

CMS nearly doubles the payment rate for administering the COVID-19 vaccine in a Medicare beneficiary’s home

A payment increase for in-home COVID-19 vaccine administration is part of a strategy to improve vaccination rates, which have slowed in recent weeks.

Nick Hut June 10, 2021
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