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…
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…
Harris Affinity Decision Support can help healthcare leaders identify meaningful areas for improvement
Improve your healthcare organization by leveraging advanced cost, performance, reimbursement and profitability data to inform and drive critical financial, operational and clinical decision-making.
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.
Susan Dentzer: Perspectives differ on Medicare’s 2 houses
Drive through rural New England and you’ll see them: “connected farms,” cobbling together houses, sheds, barns and outbuildings in disjointed structures. Often centuries old, they are at once unlovely, yet exude charm. To me, they’re a perfect metaphor for the jumble of Medicare. How else does one describe a program that baffles new enrollees as…
News Briefs: Medicare’s proposed FY24 update to inpatient payments falls short, hospitals say
Hospitals are less than pleased with Medicare’s proposed FY24 payment increase for inpatient care. In regulations released April 10, the net inpatient payment update is 2.8% after factoring in a mandatory productivity adjustment of -0.2 percentage points. As usual, the update would be reduced for any hospital that does not fulfill quality-reporting requirements or qualify…
Kaiser Permanente is set to acquire Geisinger in a deal with major industry ramifications
In a move with implications for healthcare business models, Kaiser Permanente has announced plans to acquire Geisinger and form a new nonprofit organization. Upon acquisition Geisinger will join Risant Health, an organization that is being launched by Kaiser Permanente’s hospital arm. Geisinger and future acquisitions will operate as distinct entities and retain their current branding…
FY 2024 IPPS/LTCH Proposed Rule Summary
HFMA presents a detailed summary of its proposed rule describing federal fiscal year (FY) 2024 policies and rates for Medicare’s inpatient prospective payment system and the long-term care hospital prospective payment system.
FY 2024 Skilled Nursing Facilities PPS Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule updating the Medicare skilled nursing facility (SNF) payment rates for fiscal year (FY) 2024.
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…