New report: Surging claims denials are undermining working relationships between health systems and health plans
A new report from the Healthcare Financial Management Association reveals that relationships between health systems and health plans have worsened over the past three years, with 80% of surveyed CFOs blaming health plans for increasing denials and claim adjudication errors.
Medicare’s 2025 payment updates: Why hospitals and physicians think the methodologies are flawed
Neither hospitals nor physicians found much reason for encouragement in final 2025 Medicare payment rules released Nov. 1. The rules, which were made available as pre-publication drafts, finalized a 2.9% increase for hospitals under the payment system for Medicare outpatient services and ambulatory surgical centers (ASCs). Meanwhile, physicians were dealt a 2.83% cut that they…
Election preview, a new Medicare appeals process and the two-midnight rule
Senior Editor Nick Hut and HFMA Policy Director Shawn Stack discuss the latest in healthcare finance news including pre-election thoughts, a new Medicare appeals process and application of the two-midnight rule.
The invisible costs of cancer treatment
Dr. Kamal Golla is back on the podcast this week discussing the financial considerations for patients and their care team after a cancer diagnosis.
Tribal health challenges provide lessons for healthcare organizations
Laura Osborne and John Reeves discuss the unique challenges of tribal health and what other healthcare organizations can learn from their experiences.
News Briefs: Senate hearing on Steward Health Care depicts consequences of hospital management decisions
After the CEO of Steward Health Care, Ralph de la Torre, MD, rebuffed a subpoena to appear Sept. 12 at a Senate committee hearing, members and invited panelists used the occasion to bemoan the company’s hospital ownership record and the private equity (PE) healthcare model. When de la Torre spurned the summons to appear before…
4 bipartisan healthcare policy changes are likely in 2025
HFMA policy experts see a high likelihood for far-reaching changes in healthcare policy following the November elections, with a focus on four areas: site-neutral payments, prior authorization, the 340B Drug Pricing Program, and mergers and acquisitions (M&A). The elections could produce a range of outcomes for the presidency and control of Congress. However, strong bipartisan…
Create more accurate cost reports faster with BESLER’s Easy Work Papers
A cost report is a critical reimbursement tool, but as much as 80% of it is repetitive. Check out this solution that is designed to help hospitals automatically complete the areas that repeat, so their staff has more time to focus on areas that have a real impact on the hospital’s revenue.
FTC takes legal action against pharmacy benefit managers, citing a distorted drug-pricing structure
A growing dispute between pharmacy benefit managers (PBMs) and government regulators intensified Sept. 20 when the Federal Trade Commission (FTC) filed suit against the three leading PBMs and their affiliated group purchasing organizations (GPOs). The complaint against CVS Caremark, Express Scripts, Inc. (ESI, owned by Cigna) and OptumRx (UnitedHealth Group) seeks to address a system…
Scrutiny in the Steward Health Care scandal
Nick Hut and Shawn Stack discuss the continuing bankruptcy proceedings of Steward Health Care and refusal of system CEO Ralph de la Torre to testify before the Senate.