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.
‘Concerns about access to care’ raised by OIG findings on prior authorization policies in Medicaid managed care
A year after highlighting problems with prior authorization in Medicare Advantage (MA), the HHS Office of Inspector General (OIG) has shined a spotlight on the same issue in Medicaid managed care. In the title of a new report, OIG says high rates of prior authorization denials by some Medicaid health plans “raise concerns about access…
How leveraging artificial intelligence in utilization management can enhance your revenue cycle
This white paper dives into how AI will help make healthcare sustainable and provide more of a focus on patient care. The goal is to decrease industry challenges and create new efforts to reduce the administrative cost of healthcare.
A projected Medicare physician payment decrease spurs more calls to reform the system
Physician advocacy groups vehemently expressed concern about the financial consequences of CMS’s proposed rule for Medicare physician payments in 2024, intensifying a push to modify the payment system. At a time of elevated expenses in healthcare, total payments would be reduced by a projected 1.25% relative to 2023. That would follow a 2% decrease from…
Remedy for 340B-Acquired Drug Payment Policy Proposed Rule Summary
FMA presents a detailed summary of the proposed rule describing the Agency’s proposed actions to craft a remedy relating to the adjustment of Medicare payment rates for drugs acquired under the 340B Program from calendar 2018 through September 27, 2022.
House committee approves bill requiring national provider identifiers for off-campus outpatient departments
A bill with widespread support in Congress would affect hospital billing procedures at off-campus outpatient departments if it becomes law. The House Committee on Education and the Workforce on July 12 unanimously approved legislation called the Transparency in Billing Act, which states that starting in 2024, hospital claims for items and services furnished in off-campus…
In proposed regulations, CMS seeks to strengthen hospital price transparency requirements
Hospital price transparency regulations are undergoing changes heading into their fourth year as CMS seeks to step up enforcement while making compliance more straightforward. As part of the 2024 proposed rule for hospital outpatient payments, CMS is adding to the requirement for hospitals to maintain a machine-readable file of their charges for services. In addition,…