Contracting

New data on No Surprises Act arbitration cases show providers are faring well amid systemic challenges

Providers are having success at challenging out-of-network payment amounts under the No Surprises Act, at least when they can get their cases through the arbitration system. CMS published an update showing that between April 15, 2022, when the independent dispute resolution (IDR) portal opened, and March 31, arbitrators issued payment determinations in 42,158 disputes. Initiating…

Nick Hut May 2, 2023

How managed care contracting strategies promote operational resilience

Read this article for an in depth look on several strategic steps for healthcare leaders to take to benefit their organization's managed care contracting.

HFMA April 28, 2023

Final rule for Affordable Care Act marketplace plans could expand contracting opportunities for certain types of providers in 2024

Final 2024 regulations for health plans participating in the Affordable Care Act (ACA) insurance marketplaces are designed to improve equitable access to behavioral healthcare, potentially meaning a wider array of providers will have a chance to be included in networks. As of 2023, a participating plan must have at least 35% of available essential community…

Nick Hut April 26, 2023

Healthcare disruptor Glen Tullman says providers need more of a consumer-centric approach

One of the country’s most prominent healthcare entrepreneurs has a warning for legacy healthcare stakeholders. “Many of you in the audience are leading major health systems, and you’re the hub for healthcare today,” Glen Tullman said during a presentation at the HIMSS Global Health Conference and Exhibition, which took place the week of April 17…

Nick Hut April 25, 2023

New guidance for No Surprises Act arbitration looks like an improvement for providers

Responding to a recent court ruling, the U.S. Department of Health and Human Services (HHS) has updated the application of criteria for deciding No Surprises Act (NSA) independent dispute resolution (IDR) cases. Certified IDR entities (i.e., arbitrators) received guidance March 17 instructing them to more directly consider multiple factors when deciding on an out-of-network payment…

Nick Hut March 20, 2023

Financial and operational pressures continue for hospitals amid some positive signs

New financial data for the hospital industry illustrate continuing challenges even as some trends improve. Fitch Ratings released an analysis in early March that offers scant reason for optimism. Titled “Early NFP Hospital Medians Show Expected Deterioration; Will Worsen,” it draws on data from hospitals with earlier 2022 financial year-ends. Those numbers show “materially weaker…

Nick Hut March 6, 2023

Affordability of healthcare is not enhanced when providers form health systems, studies find

The efficiencies gained when providers operate as a health system don’t always translate to care that is more cost-effective, according to two recently published JAMA studies on pricing. In one study, researchers with Harvard Medical School and the National Bureau of Economic Research (NBER) examined 2018 data from various sources, including CMS administrative data, IRS…

Nick Hut March 1, 2023

News Briefs: 2023 brings a steep fee hike for No Surprises Act arbitration cases

The No Surprises Act’s independent dispute resolution (IDR) process has become more expensive for healthcare stakeholders. For the new year, the nonrefundable administrative fee due from each party involved in any payment dispute that goes to arbitration increased from $50 to $350, according to a Dec. 23 memo from CMS’s Center for Consumer Information and…

Nick Hut January 27, 2023

Key points to know in recently proposed rules for Medicare Advantage and the ACA marketplaces

A proposed rule for health plans in Medicare Advantage has provisions designed to stem overreach in prior authorization processes.

Nick Hut January 20, 2023

Most healthcare organizations want to augment current EHR workflows and would consider flexible outsourcing contracts

This pulse survey shows that there is no one-size-fits-all solution for managing today’s revenue cycle challenges. Savvy healthcare organizations know they need a combination of actionable insights and high-performance work teams to be successful.

HFMA December 1, 2022
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