Health Plan Payment and Reimbursement

Front-line stories: How today’s prior authorization processes create a burden of waste for providers

As hospitals continue to struggle with razor-thin margins, they should actively identify activities that create financial burdens for them without delivering value to patients. One health system’s stories of administrative waste due to prior authorization processes show why this activity should be be high on their list.

Alan S. Kaplan, MD, MMM, FACPE February 19, 2021

Report: Large sampling reveals 30% of hospitals haven’t complied with any aspect of the new price transparency requirements

Hospitals have had an easier time posting the required price information for consumer-friendly shoppable services than for all the services in their chargemaster, according to a large survey.

Nick Hut February 13, 2021

A look at some of the healthcare-specific provisions in the pending COVID-19 relief legislation

As a $1.9 trillion COVID-19 relief package makes its way through Congress, provisions under consideration could affect the Provider Relief Fund, the Affordable Care Act insurance marketplaces and Medicaid.

Nick Hut February 11, 2021

Panel: How the healthcare industry can achieve a higher-value and more equitable system

A panel of experts explored how to make healthcare more effective both generally and for underserved demographics specifically.

Nick Hut February 1, 2021

Biden’s order to reopen the ACA marketplaces next month draws praise from hospitals

An executive order by President Joe Biden directed HHS to open the Affordable Care Act marketplaces for three months starting in mid-February.

Nick Hut January 30, 2021

Healthcare News of Note: Recent CMS regulations are in limbo under the new administration

News of Note for healthcare finance professionals is a roundup of articles from the past weeks, including, the Biden administration ordering a review of recently finalized regulations across government agencies, leaving the fate of several new CMS rules in question.

Deborah Filipek January 22, 2021

Nov. 11-15: HFMA’s Virtual Conference among next week’s healthcare finance events

HFMA’s Virtual Conference is among the major healthcare finance events taking place the week of Nov. 11.

Rich Daly January 22, 2021

Healthcare News of Note: Noncompliance with new price transparency rules appears to be common

CMS's auditing of price transparency commpliance and Tennessee's Medicaid block grant program waiver getting approved are two topics in Healthcare News of Note. Also, HFMA revamps its “Voices in Healthcare Finance” podcast.

Deborah Filipek January 15, 2021

New legislation seeks to take unwelcome surprises out of patient billing

A new law called The No Surprises Act is designed to prevent healthcare consumers from getting stuck with potentially large bills after receiving out-of-network care.

Nick Hut January 11, 2021

Healthcare News of Note: Payers push back on CMS prior-authorization rule

Healthcare News of Note for healthcare finance professionals is a roundup of articles from the past week, including why payers are pushing back on the prior-authorization rule and information on HHS funding to support the nation's response to the COVID-19 pandemic.

Deborah Filipek January 11, 2021
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