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…
Are you ready for the Medicaid ‘unwinding?’
The phase-out, or “unwinding,” of the three-year Medicaid continuous enrollment program began on April 1, and states have started to disenroll ineligible members. They have 12 months to complete the recertification process. The HHS estimates that around 8.2 million Medicaid enrollees, of which 4.7 million are adults ages 18 to 34, will lose Medicaid coverage, while 5.3…
How the patient financial experience impacts loyalty
Healthcare organization leaders from across the country share insight on creating patient financial experiences that drive payment while protecting patient retention in this roundtable.
5 issues that are keeping healthcare compliance professionals up at night
Rarely has the compliance landscape been more muddled or presented more of a challenge for healthcare organizations. “I’ve been a compliance officer for about 20 years now, and I’ve been in healthcare forever,” said Kirsten Wild, RN, a nurse by background who now owns a healthcare compliance consultancy. “But the volume and the pace of…
Gail Wilensky: No Surprises Act — where things stand after 16 months
Few areas of concern within our nation’s healthcare system have caused patients, their families and caregivers more consternation than surprise medical bills. Most of the new protections under the 2020 No Surprises Act became effective on Jan. 1, 2022. Last August, the Departments of Labor, Health and Human Services and Treasury released a statement providing…
Enterprisewide physician advisor programs are key to improving costs and revenue cycle performance
Making sure physicians understand the financial implications of how they document their care is critical to a health system’s financial sustainability.
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…
Healthcare disruptor Glen Tullman says providers need more of a consumer-centric approach
One of the country’s most prominent healthcare entrepreneurs has a warning for legacy healthcare stakeholders. “Many of you in the audience are leading major health systems, and you’re the hub for healthcare today,” Glen Tullman said during a presentation at the HIMSS Global Health Conference and Exhibition, which took place the week of April 17…
HFMA learner uses revenue cycle certification to raise healthcare finance quality
Dr. Naif Alhakbani, revenue cycle management officer at Kidney Care Company, Saudi Arabia, recently shared with HFMA his enthusiasm for helping healthcare organizations optimize their revenue cycle and improve financial performance. “By improving their finances and clinical integrity, healthcare providers can receive payment for the services they provide, allowing them to continue to provide high-quality…
Healthcare News of Note: What can be done to correct data disparities in women’s health?
The prevalence of women’s health conditions is roughly five times that of their documented diagnoses, which means for every woman diagnosed with a women’s health condition, roughly four go undiagnosed. The 2023 emergency medicine Match will see 555 initially unmatched positions, affecting a larger number of residency programs than in 2022, when 219 unmatched positions…