Health Plan Payment and Reimbursement

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

Why fee-for-service can have a place in a reimagined healthcare system, but not as the primary mode of payment

Fee-for-service came under fire during a workshop in which prominent healthcare industry experts spoke of ways to achieve better integration of financing and care delivery.

Nick Hut June 9, 2021

Why closer collaboration between healthcare providers and health plans is crucial, and where it could pay off the most

New types of provider-payer associations place an emphasis on increasing the value of healthcare rather than merely offering cost savings.

Nick Hut June 4, 2021

Survey data highlights shortcomings in private insurance coverage compared with Medicare

Indicators of coverage gaps were more likely to be seen among individuals with private insurance.

Nick Hut June 2, 2021
googletag.cmd.push( function () { googletag.display( 'hfma-gpt-leaderboard' ); } );