Recent updates and emerging best practices for ACOs in the Medicare Shared Savings Program
Going into the 12th year since it brought accountable care into the healthcare lexicon, the Medicare Shared Savings Program (MSSP) continues to evolve, with CMS making changes and participants fine-tuning best practices. Starting with 220 accountable care organizations (ACOs) in 2012-13, the MSSP grew to 561 in 2018. However, the number has been below 500…
Empowering patient access teams: The transformative impact of training and development
Hospital patient access teams are often the first encounter a patient has with the hospital. The patient access encounter sets the stage for the entire patient experience and has financial implications as well. Effective registration, eligibility verification, coverage discovery and collection workflows are required for optimal revenue cycle outcomes. Training and development have a big…
3 key interventions to address lagging payer reimbursements
It seems as if commercial payers are doing all they can to keep from reimbursing providers in a timely manner. According to a recent report by Crowe, 31% of claims submitted to commercial payers in the first quarter of 2023 were not paid for at least three months, as compared with 12% of Medicare claims.…
Medicaid DSH payment cut barely averted as House, Senate pass short-term federal funding
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 ensures a four-year, $32 billion Medicaid DSH cut will not take effect before Nov. 17. Most importantly, the bill bought time…
Update: Medicaid DSH payment cut averted as House, Senate pass short-term federal funding
Note: The headline and lead section of this article were updated Oct. 1 with news of a six-week government funding extension that delays the Medicaid DSH cuts and pays for other healthcare programs. The article originally was published Sept. 28 under the headline, “An $8 billion Medicaid DSH cut is closer to happening as a…
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…
A crisis of faith regarding value-based care
As the movement to reduce or eliminate fee-for-service payment in favor of value-based payment plods along, some in the industry are voicing doubts that it is ever going to happen or that it is even necessary. An HFMA survey conducted in February and March for the “Healthcare 2030” series of special reports finds some of…
The No Surprises Act arbitration portal is temporarily closed for business after providers’ latest legal victory (updated)
Note: See the bottom of this article for the latest updates. The U.S. Departments of Health and Human Services (HHS), Labor and Treasury on Friday temporarily shut down the system for settling disputes over out-of-network payment amounts under the No Surprises Act. A day earlier, a federal judge gave the Texas Medical Association (TMA) the…
5 things to know about Medicare’s FY24 final rule for inpatient payments as hospitals foresee adverse impacts
The FY24 final rule for Medicare inpatient payments didn’t bring hospitals the type of rate update they sought, and for some organizations a bigger concern is changes to uncompensated care (UC) payments and disproportionate share hospital (DSH) payments. Here are five big points about the regulations, which take effect Oct. 1 and also cover Medicare…
A projected Medicare physician payment decrease spurs more calls to reform the system
Physician advocacy groups vehemently expressed concern about the financial consequences of CMS’s proposed rule for Medicare physician payments in 2024, intensifying a push to modify the payment system. At a time of elevated expenses in healthcare, total payments would be reduced by a projected 1.25% relative to 2023. That would follow a 2% decrease from…