Key questions for providers after more than 2 years of the price transparency rule
Evidence amassed from over two years of experience with compliance reinforces why providers need to focus on chargemaster prices and self-pay discount policies — and how they can benefit from analyzing trends in consumers’ price searches.
No Surprises Act litigation update: QPA methodology deemed illegal as Texas Medical Association wins in court again (updated)
Note: The first section of this article has been updated with the latest news on the status of the arbitration portal. The fourth victory in four cases brought by the Texas Medical Association (TMA) has implications for how insurers calculate the qualifying payment amount (QPA) used to arbitrate out-of-network payment sums under the No Surprises…
FY 2024 Skilled Nursing Facilities PPS Final Rule Summary
HFMA presents a detailed summary of the final rule updating the Medicare skilled nursing facility (SNF) payment rates for FY 2024.
Children’s hospitals swim against the tide to improve the health of their patients and communities
As the nation’s pediatric hospitals strive to keep kids healthy, they face obstacles that reflect the difficulty of enacting structural changes in care delivery. Even pediatric hospitals that are eager to engage in value-based payment (VBP) models can have a hard time establishing the type of network that allows them to affect the holistic health…
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…