Payment Reimbursement and Managed Care

CY 2023 Physician Fee Schedule Final Rule Summary Part III – Quality Payment Program Updates

HFMA presents Part III of three detailed summaries of the final rule relating to the Medicare physician fee schedule for CY 2023 and other revisions to Medicare Part B policies.

HFMA December 16, 2022

The hospital labor picture could be improving, but a full financial recovery isn’t imminent

The financial and operational stress that has hampered hospitals may be easing in some ways, but probably not enough to qualify as a holiday gift for a beleaguered industry. Recent reports from credit-rating agencies have presented a mixed outlook. For example, Fitch Ratings released an analysis in December showing “incremental signs of improvement” in the staffing situation…

Nick Hut December 15, 2022

Healthcare News of Note: Advocate Aurora Health and Atrium Health megamerger complete

Healthcare News of Note for healthcare finance professionals is a roundup of recent news articles: Atrium and Advocate Health close merger deal, CMS details expectations of hospitals in memo addressing workplace violence, and CMS plans to recoup $650 million in overpayments to Medicare Advantage plans.

Deborah Filipek December 12, 2022

New federal rule aims to eventually ease prior authorization processes

CMS is seeking to improve the prior authorization process in government programs such as Medicare Advantage (MA) and Medicaid, although the core provisions would not begin until 2026. The agency this week updated a Trump administration proposed rule with new proposals to “improve patient and provider access to health information and streamline processes related to prior authorization…

Nick Hut December 9, 2022

CY 2023 Physician Fee Schedule Final Rule Summary Part II – Medicare Shared Savings Program Requirements

HFMA presents Part II of three detailed summaries of the final rule relating to the Medicare physician fee schedule for CY 2023 and other revisions to Medicare Part B policies. Part II covers the Medicare Shared Savings Program Requirements.

HFMA December 8, 2022

Reimbursement changes for 340B drugs reverberate in Medicare’s 2023 outpatient payment final rule

The Medicare payment rate for hospital outpatient services will increase significantly in 2023, but the net gain for the sector will be less than is apparent at first glance. Payment rates for hospital outpatient care and ambulatory surgical centers technically will increase by 3.8% over 2022 for facilities that meet quality-reporting requirements, CMS said in…

Nick Hut December 7, 2022

HHS says the co-provider requirement for good-faith estimates is being tabled indefinitely

The U.S. Department of Health and Human Services has given hospitals and other healthcare providers a break on enforcement of a looming requirement for co-providers to be included on good-faith estimates (GFEs) furnished to uninsured patients.  HHS announced in an updated FAQ that it will continue to exercise “enforcement discretion” instead of potentially penalizing providers starting Jan.…

Nick Hut December 5, 2022

Cloudmed, an R1 company, helps health systems get paid for the care they provide

Using one company’s AI platform, health systems will find uncovered funds that can be used to hire essential practitioners, build new facilities and fund outreach programs.

HFMA December 5, 2022

CY 2023 Physician Fee Schedule Final Rule Summary Part I

HFMA presents Part I of three detailed summaries of the final rule relating to the Medicare physician fee schedule for CY 2023 and other revisions to Medicare Part B policies.

HFMA December 2, 2022

How a Hospital or Health System Can Assess the Risk of Moving to Value-Based Payment

To gain a clearer understanding of the financial impact of transitioning to a value-based model, healthcare executives can learn from the experiences of another health system that has undertaken a similar migration.

Ross Armstrong December 2, 2022
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