Cyberattack leaves hospitals scrambling in several states
A recent attack was the latest to illustrate the potential of cybercriminals to cause havoc across an interstate health system. The Los Angeles-based Prospect Medical Holdings system incurred a ransomware attack Aug. 3 that temporarily required some patients to be diverted from emergency departments and relegated hospitals to using paper records and incorporating other downtime…
The No Surprises Act arbitration portal is temporarily closed for business after providers’ latest legal victory (updated)
Note: See the bottom of this article for the latest updates. The U.S. Departments of Health and Human Services (HHS), Labor and Treasury on Friday temporarily shut down the system for settling disputes over out-of-network payment amounts under the No Surprises Act. A day earlier, a federal judge gave the Texas Medical Association (TMA) the…
In proposed regulations, CMS seeks to strengthen hospital price transparency requirements
Hospital price transparency regulations are undergoing changes heading into their fourth year as CMS seeks to step up enforcement while making compliance more straightforward. As part of the 2024 proposed rule for hospital outpatient payments, CMS is adding to the requirement for hospitals to maintain a machine-readable file of their charges for services. In addition,…
Medicare coverage and coding updates: New Alzheimer’s drugs to be covered, but not universally
Note: This article was updated July 6. For drugs manufactured to slow the progression of Alzheimer’s disease, Medicare will offer coverage with certain qualifications, according to a recent CMS announcement. The new policy especially is relevant because the FDA’s first full approval of an Alzheimer’s disease drug may be only a month or so away.…
Interoperability rule enforcement is coming. Are you ready?
Rita Bowen of MRO discusses why some organizations are choosing not to ready themselves for interoperability until enforcement begins and how reproductive care can throw a wrench into the process.
News Briefs: The expiration of the COVID-19 PHE brings an end to key provisions
The termination of the COVID-19 public health emergency (PHE) on May 11 meant providers lost many of the accommodations and regulatory flexibilities that were in place since Jan. 31, 2020. For example, Medicare’s 20% add-on payment for treating COVID-19 cases in the inpatient setting no longer is available. With reported cases and hospitalizations steadily trending…
Healthcare providers seeing more diagnosis-related group downgrades and ghost denials
Each year, tens of millions of medical claims will be denied by healthcare payers. One executive director led a session with more than a dozen attendees highlighting their experiences with DRG downgrades and lessons learned to help other organizations better measure, manage and successfully appeal these complex denials.
Healthcare News of Note: 3 factors increase the likelihood that a physician has been sued
Some46.8% of physicians over the age of 54 report they have been sued compared to 9.5% of physicians under the age of 40. The revenue cycle management segment accounted for the largest revenue share in the global healthcare finance solutions market in 2022. Greater representation of Black primary care physicians (PCPs) in the PCP workforce…
Hospital price transparency updates include stricter enforcement, new fines and pending legislation
(Note: The last section of this article was updated May 24 where noted to reflect developments in Congress.) Enforcement of hospital price transparency regulations is becoming stricter, with CMS implementing new policies and recently fining two hospitals. Changes were anticipated after CMS leaders authored an article in February that reported 70% compliance in 2022, the…
The COVID-19 public health emergency is over: Here’s what healthcare providers should know
An era ends for the U.S. healthcare industry with the termination of the COVID-19 public health emergency (PHE) at the close of the day on Thursday, May 11. The termination means providers are losing many of the federal waivers and flexibilities that have been in place for all or most of the PHE, which took…