Why Fee-For-Service Remains Prominent
Fee-for-service is still the dominant payment method because of certain economic factors and a traditional industrial mindset that values volume.
How to Really Know Your Payment Rates
A deep understanding of active contracts, combined with proactive and purposeful performance monitoring and open communication with health plans must be in place to ensure that hospitals are appropriately paid and the incentives available to them are aligned.
Maryland Insurance Costs Rise Despite Hospital Price Controls
July 24—Despite a unique price control system for Maryland hospitals, insurers in the state’s Affordable Care Act (ACA) individual health insurance market have requested the largest average rate increase in the country.
3 Strategies for Taking Control of Payer Management
Three strategies can help hospitals and health systems prioritize payer contract management.
Congress Pushes 340B Bills to Cut Eligibility, Increase Reporting
July 11—Members of Congress this week pushed emerging legislation to restrict the ability of hospitals and other providers to qualify for the 340B discount drug program and to increase their reporting requirements.
Hospitals Worry Rule Could Lead to Medicaid Rate Cuts
May 23—Proposed changes to federal Medicaid rules could hit hospitals’ bottom lines, advocates warned.
Confirming Eligibility of ACA Medicaid Enrollees ‘Top Priority’ of Administration
April 13—Amid a recent finding that three states spent more than $1 billion on enrolling ineligible Medicaid beneficiaries, the Trump administration is prioritizing the verification of eligibility among the 11 million who were added to the Medicaid rolls through healthcare reform.
Medicaid Waivers: Work Requirements Are Not the Only Changes Coming
Work requirements present unknown changes and impacts, but the impact may not be as big as some assume. However, what providers and recipients need to consider are the other and seemingly less significant changes that will intensify the overall impact of an 1115 Medicaid demonstration waiver.
FFS Medicaid Most Challenging for Billing: Study
April 4—One of the first direct comparisons of billing complexities between various types of payers found that Medicaid fee-for-service (FFS) programs were the most challenging for providers.
Building a Resilient Managed Medicaid Program in the Face of Uncertainty
By collaborating with state agencies, a provider-sponsored health plan has thrived and expanded in an economically disadvantaged area.