Administrative prior authorization requirements increasingly used to steer patients to lower-cost settings
Hospital finances could be significantly impacted by UnitedHealthcare’s expansion of site-of-service prior authorization requirements going into effect Nov. 1.
Analysis: What to expect after the Texas vs. Azar ruling
There’s still much to be argued and dealt with regarding Texas versus Azar, and no final decision on the ACA should be expected until June 2020 at the earliest.
Healthcare reform moves to the states: Strategies to increase access and control costs
An increasing number of states are looking to improve access and reduce costs by funneling innovations, such as a public option or reinsurance program, through Medicaid.
Addressing the largest area of healthcare waste requires plans and providers to collaborate
Plans and providers should work together to systematically catalog the biggest administrative complexities responsible for unnecessary healthcare spending and develop a standardized approach to reduce or eliminate them.
Analysis: Initial thoughts on the President’s recent Medicare executive order
A review and insight on several key points in the President’s Medicare executive order issued Oct. 3.
Direct contracting models offer promise of expedited shift to value-based care
CMS’s Direct Contracting Models offer providers some substantial benefits, including access to capitation payments for Medicare fee-for-service members — without the investment costs in brokers and marketing to move members into Medicare Advantage.
Analysis: How a longer-term delay to Medicaid DSH cuts may play out
A review of CMS’s recent rule finalizing the ACA’s mandated Medicaid DSH cuts for FY2020 and how it may play out if some legislators demand changes to the rule.
Analysis: Wage index changes in the IPPS Final Rule
A review of why a couple of the key changes to the CMS FY2020 IPPS Rule may not bring the desired results.
Analysis: CMS final discharge planning rule
A review of the final rule and suggestions for related HFMA resources.
Analysis: Tennessee proposes an overhaul to funding of its Medicaid program
HFMA's Chad Mulvany reviews Tennessee’s proposal to overhaul funding of its Medicaid program and shares why CMS is likely to reject it.