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…
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.…
Utilization Review: 5 Reasons Hospitals Lose Revenue
An effective utilization review program must revolve around the right management and processes as well as communication among teams.
Cracking the Code on Physician Practice Performance
In many respects, today’s physician practice operating model isn’t working. Not only is there wide variation in patient care and operations management across medical groups, but there are numerous challenges with which practices continue to struggle, such as limited resources, operational complexity, physician burnout, patient satisfaction, and rising costs. Taken together, these multifaceted dynamics can…
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.
News Briefs: TMA returns to court over concerns about the No Surprises Act’s arbitration process
The Texas Medical Association has gone to court for a second time in less than a year over the independent dispute resolution process that’s part of the No Surprises Act.
Final regulations for rural emergency hospitals set the stage for first year of eligibility
REHs will be reimbursed for providing emergency care and outpatient services and must abide by terms and conditions that include limiting average length of stay to 24 hours.
10 Steps Toward Health Equity
The push to achieve equity in health and healthcare is daunting. It’s a multifaceted societal quest in which the goal is to fix disparities that have been entrenched throughout U.S. history. HFMA’s 2022 Thought Leadership Retreat brought together stakeholders from across healthcare Sept. 15-16 in Washington, D.C., to advance the dialogue in this effort. Although…
Changes to reimbursement for 340B drugs reverberate in the 2023 final rule for Medicare outpatient payments
The Medicare payment rate for hospital outpatient services will increase significantly in 2023, but the net gain will be quite a bit less than is apparent at first glance.
When it comes to healthcare price transparency regulations, questions abound
A new era for healthcare price transparency has been underway for almost two years, but the potential impact remains murky. Price transparency requirements for hospitals were drafted by CMS during the Trump administration and went into effect Jan. 1, 2021. A companion rule for health plans was set to begin a year later, but the…