Employer-sponsored healthcare coverage would benefit from better access to data, Congress is told
Employers can stimulate efforts to improve the value of healthcare, but they need help in the form of better access to claims data and prices, according to testimony at a recent congressional hearing. With those tools in hand, employers can more easily forge provider partnerships that lower costs and raise healthcare quality, health benefit administrators…
Why providers are struggling to succeed under value-based care
An obvious question that has often been overlooked in the rush to promote value-based care (VBC) is whether providers are equipped to navigate the transition from volume to value. Findings of a survey of providers and payers published in September suggest that there are reasons for concern.a Many providers report that capability gaps are negatively…
Limit financial risk from Medicaid redetermination
Medicaid redetermination isn’t going smoothly. As of late December 2023, the Kaiser Family Foundation found that 71% of Medicaid disenrollments nationwide were for procedural reasons. That means patients are losing coverage because they filled out a form incorrectly or missed a deadline, not because they’re truly ineligible for renewal. Provider organizations can play a pivotal…
In Congress, it’s status quo for Medicaid DSH payments and the Medicare physician fee schedule
Yet another short-term federal funding measure from Congress included yet another brief extension of full funding for Medicaid disproportionate share hospital (DSH) payments. With funding for much of the federal government set to expire Jan. 19, Congress agreed on a continuing resolution that keeps all agencies fully operational until March. Medicaid DSH payments are guaranteed…
Medicare beneficiaries would have new options for appealing their hospital patient status under a proposed rule from CMS
A proposed rule from CMS would affect the appeals process for some patients whose status is reclassified from inpatient to outpatient observation during a hospital stay. After a 2020 court ruling that was upheld at the appellate level in 2022, the U.S. Department of Health and Human Services and CMS were obligated to create additional…
The state of U.S. primary care: How new ways of thinking can spur meaningful improvement
As healthcare stakeholders consider ways to fortify the nation’s primary care system, industry leaders recommend emphasizing several strategies and components — and not waiting to act. “We’re close to midnight in many respects in thinking about how to urgently preserve and expand primary care in America,” Susan Dentzer, president and CEO of America’s Physician Groups…
Recent updates and emerging best practices for ACOs in the Medicare Shared Savings Program
Going into the 12th year since it brought accountable care into the healthcare lexicon, the Medicare Shared Savings Program (MSSP) continues to evolve, with CMS making changes and participants fine-tuning best practices. Starting with 220 accountable care organizations (ACOs) in 2012-13, the MSSP grew to 561 in 2018. However, the number has been below 500…
Comparison of 2024 ASC Addendum BB with October 2023 Addendum BB
HFMA presents a spreadsheet comparing ASC covered ancillary services. It also includes an HCPCS lookup tool that makes it easier to pull-up descriptive and payment information for a particular code.
Comparison of 2024 ASC Addendums AA and FF with October 2023 Addendums
HFMA presents a spreadsheet for relative weights and payment rates for the Ambulatory Surgical Center payment system comparing 2024 to 2023 rates.
Definition of “Employer”—Association Health Plans Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule published by the Employee Benefits Security Administration that would rescind the similarly titled rule finalized in 2018 (83 FR 28912) that expanded the regulatory definition of “employer” under the Employee Retirement Income Security Act of 1974.