Prior authorization in Medicare Advantage remains in the policy spotlight as 2024 regulations take effect
Healthcare policymakers and stakeholders continue to mull the need for guardrails to ensure optimal customer service among Medicare Advantage (MA) health plans. The American Hospital Association wrote a Nov. 20 letter to CMS stating that MA plans are looking to skirt policies designed to ensure straightforward coverage of essential healthcare services. These policies, finalized earlier…
Congress doesn’t seem to be mulling a fix for the 2024 Medicare physician payment cut
Congress has mitigated a scheduled Medicare payment cut for physicians going into each of the last three years, but relief does not appear to be on the way for a fourth year running. Medicare’s 2024 final rule for physician payments includes a $1.15 decrease to the conversion factor, amounting to a reduction of more than…
Proposed rule sets Medicare penalties for providers that commit information-blocking infractions
Hospitals and other healthcare providers would face penalties for knowingly engaging in information blocking, with the sanctions affecting their Medicare reimbursement, according to a proposed rule from the U.S. Department of Health and Human Services (HHS) and CMS. Published at the beginning of November, the rule implements some terms of the 21st Century Cures Act,…
Decoding revenue cycle management: Top coding questions providers ask
Quality coding is vital to a healthy revenue stream. Each member of the coding team must possess the skills and knowledge necessary to capture detailed and precise information regarding patient encounters, procedures, diagnoses and treatments. Because incorrect coding falls under the “fraud and abuse” category of the American Medical Association’s Principles of CPT Coding, penalties can…
Healthcare News of Note: Health systems benefit from hike in use of patient portals
Over the past few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals. 1. Greater patient use of online medical records and patient portals could improve patient health and benefit health systems “Improved patient outcomes” and “significant health system benefits,” are likely results of more patients in…
CMS finalizes enhanced hospital price transparency requirements for 2024
Hospital price transparency mandates are set to become more stringent in the coming year as CMS seeks to strengthen regulations that have been on the books since 2021. Medicare’s 2024 final rule for hospital outpatient payments includes updates to the price transparency rules. Hospitals will need to post charge information using a more precise template,…
Medicare’s hospital outpatient payment rate for 2024 improves marginally from the proposed rule
The final rule setting Medicare’s 2024 payment rates and policies for hospital outpatient services and ambulatory surgical centers (ASCs) contained no major surprises and little to make hospitals optimistic about the government portion of their payer mix. Here are five of the most important payment and coverage takeaways from the rule, which totals 1,672 pages…
News Briefs: Medicaid DSH payment cut barely averted in September, still possible in November
Hospitals received a last-day reprieve from substantial cuts to Medicaid disproportionate share hospital (DSH) payments, with House leaders reversing course Sept. 30 and ushering through a six-week government funding package. Language in the bill ensured the start of a four-year Medicaid DSH cut amounting to $32 billion was pushed back from Oct. 1 to Nov.…
The No Surprises Act: How healthcare organizations can create a winning strategy
Find a breakdown of the No Surprises Act in this business profile with an update on four main administrative requirements of the bill and insight to improve hospitals and healthcare systems using technology for future regulatory changes.
Hospital, physician advocates disagree over the role of physician-owned hospitals as policymakers ramp up focus
Hospital advocacy groups hope to stanch momentum that’s building in policy circles to increase the number of physician-owned hospitals. The American Hospital Association (AHA) and Federation of American Hospitals (FAH) issued a joint statement Oct. 18, saying permitting greater numbers of physician-owned hospitals (POHs) would have adverse effects on healthcare costs, access and quality. The…