Healthcare News of Note: DOL sues UnitedHealth Group subsidiary for claim denials
The U.S. Department of Labor recently sued UMR Inc., the nation’s largest third-party healthcare claims administrator, for denials involving emergency department services and urinary drug screening. Twenty-two of U.S. News & World Report’s Best Hospitals also made the publication’s honor roll, which recognizes hospitals for demonstrating exceptional breadth of excellence across clinical specialties. Substantial resources…
Navigating Medicare’s 2024 inpatient payment rule
On Aug. 1, 2023, CMS published its final rule for federal FY24 inpatient prospective payment system (IPPS). Undoubtedly, navigating such complexity in a healthcare rule can be quite challenging. The purpose of this blog post is to provide some much-needed clarity regarding the new rule, enabling healthcare finance leaders to direct their attention towards the…
FY 2024 Hospice Payment Rate Update Final Rule Summary
HFMA provides a detailed summary of the final rule updating the Medicare hospice payment rates, wage index, the cap amount and the quality reporting requirements for FY 2024.
Healthcare News of Note: 10 drugs account for a large share of Medicare Part D spending
In total, Part D gross spending rose from $166 billion in 2018 to $216 billion in 2021. In 2023, customer personal identifiable information costs organizations $183 per record and employee PII costs $181 per record. Average length across all clinical notes increased 8.1%, from 4,628 characters in May 2020 to 5,002 characters in April 2023. …
FY 2024 Inpatient Psychiatric Facilities PPS Final Rule Summary
HFMA presents a detailed summary of the FY 2024 final rule released by CMS that rebases and revises the inpatient psychiatric facilities (IPF) PPS market basket to reflect a 2021 base year and makes other changes affecting IPF PPS rates.
Medicare’s proposed remedy for 340B-acquired drug underpayments: Addressing only half at best?
On July 7, 2023, CMS released a proposed rule, identified as CMS-1793-P, which outlines the agency’s intended actions to address the adjustment of Medicare payment rates for drugs acquired under the 340B Drug Pricing Program. This proposed rule pertains to the period spanning from calendar year 2018 through Sept. 27, 2022. The necessity for this remedy…
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…
FY 2024 Inpatient Rehabilitation Facility PPS Final Rule Summary
HFMA presents a detailed summary of the final rule issued by CMS on the Medicare inpatient rehabilitation facility prospective payment system for FY 2024.
5 things to know about Medicare’s FY24 final rule for inpatient payments as hospitals foresee adverse impacts
The FY24 final rule for Medicare inpatient payments didn’t bring hospitals the type of rate update they sought, and for some organizations a bigger concern is changes to uncompensated care (UC) payments and disproportionate share hospital (DSH) payments. Here are five big points about the regulations, which take effect Oct. 1 and also cover Medicare…
Dr. Ronald Hirsch of R1 RCM discusses new Alzheimer’s drug Leqembi with HFMA’s Nick Hut
Dr. Ronald Hirsch of R1RCM discusses considerations around a new Alzheimer's drug with Senior Editor Nick Hut.