HHS sets new administrative fee to be paid by parties in No Surprises Act independent dispute resolution cases
Oct. 6 update: The lead section of this article was updated where noted with news about the arbitration portal. The administrative fee for taking out-of-network payment disputes to arbitration under the No Surprises Act in 2024 would be significantly lower than it was for much of 2023, but triple the current rate, according to proposed…
Driving dollars through data: An innovative way to improve self-debt collections
Recent industry trends indicate the challenge of self-pay collections within the revenue cycle management (RCM) space will continue to rise, driven primarily by the increasing number of consumers opting for high deductible health plans. Effective collections strategies require additional expertise to focus efforts where there is a higher return on investment. It’s time-consuming to chase…
As clock ticks toward massive Medicaid disproportionate share hospital cuts, proposed bill would bring relief
A congressional bill that would impose additional transparency requirements on providers also would offer a respite from a sizable cut to a key supplemental payment. A $32 billion reduction to Medicaid disproportionate share hospital (DSH) payments is scheduled to span four years, beginning when federal FY24 gets underway Oct. 1. The Lower Costs, More Transparency…
Legislation to enhance healthcare pricing and billing transparency takes a big step forward in the House
A slew of provisions on healthcare transparency took a step closer to becoming federal law as three House committees last week merged separate bills into a single draft. The resulting bill is just about set for consideration by the full House, where bipartisan support for the major provisions was apparent in the committee phase. The…
How predictive analytics and AI shed light on payer behavior
Providers and payers have become more collaborative as payment models evolve toward value. Still, payer-provider relationships can seem one-sided — decidedly in favor of the payer — as hospitals continue to face declining reimbursement and rising costs. The increase in denials is a great example, with rates skyrocketing by 20% over 5 years, according to…
Stemming the outpatient profit squeeze with a revenue cycle workflow gap analysis
Hospital and health system outpatient, outreach and ancillary services are often confined to EHR systems to manage their billing. Designed for bigger-ticket, lower-volume claims, these systems lack specific front-end intelligence, system connectivity, and automation necessary to efficiently manage these departments’ unique billing need. Too often, the result is an unnecessarily high number of submission errors,…
Patient access: The key to a healthy revenue cycle
As hospitals and physician groups face ongoing labor shortages and skyrocketing costs, maintaining effective Patient Access processes is critical. Ensuring efficiency and accuracy upstream helps prevent delayed reimbursement downstream—while supporting a positive patient experience. Download this whitepaper to explore the three patient access processes that can help protect revenue and improve the patient experience. Identify…
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…
Data indicate hospital operational logjams haven’t ceased after the public health emergency (updated)
Note: The fourth section of this article has been updated with news of proposed mandatory staffing ratios for long-term care facilities. Some of the problems that strained hospital operations during the peak of the COVID-19 pandemic have eased, but not enough to mark a true industrywide recovery, a recently released report suggests. Notably, the process…
HFMA, Selat/Nawa and KSA Ministry of Health collaborate on one-day educational event in Riyadh
The Healthcare Financial Management Association (HFMA) is offering a new international educational opportunity with a one-day healthcare finance event, at the Global Health Exhibition in Riyadh on Oct. 31. Selat, a Riyadh-based revenue cycle management consulting firm and its training arm Nawa, is the exclusive sponsor of the event and will also provide instruction during…