Medicare Payment and Reimbursement

News Briefs: Financial and operational pressures continue for hospitals amid scattered positive signs

Recent financial data for the hospital industry illustrate continuing challenges even as some trends improve. Fitch Ratings released an analysis in early March that offers scant reason for optimism. Titled “Early NFP hospital medians show expected deterioration; will worsen,” it draws on data from hospitals with earlier 2022 financial year-ends. Those numbers show “materially weaker…

By Nick Hut March 30, 2023

Best practices for relieving unprecedented cost pressures facing healthcare providers

Due to labor cost increases, inflation, declining Medicare reimbursements and other reasons, health systems across the nation are feeling a new financial strain after the height of the pandemic.

By HFMA March 29, 2023

Medicare Drug Price Negotiation Program Guidance

HFMA presents a summary of CMS proposed initial guidance memorandum pertaining to the Medicare Drug Price Negotiation Program.

By HFMA March 27, 2023

Healthcare News of Note: Medicare to negotiate reduced prices for 40 drugs by 2028, says study

Medicare drug price negotiation has the potential to benefit Medicare beneficiaries across some of the most common disease states.

By Deborah Filipek March 23, 2023

Highlights of the Administration’s FY 2024 Budget

HFMA presents a summary of healthcare-related proposals included in the President’s budget for fiscal year 2024, released by the Biden Administration on March 9, 2023.

By HFMA March 21, 2023

Medicare DSH Adjustment and Section 1115 Waiver Days Proposed Rule Summary

HFMA presents a detailed summary of the proposed rule published by CMS that would change the policies on how the Medicare disproportionate share adjustment is determined, relating to the counting of days associated with individuals eligible for certain benefits provided by section 1115 demonstrations.

By HFMA March 9, 2023

News Briefs: Healthcare industry disrupter CVS Health to shell out billions to buy Oak Street Health

A month after stating it hoped to gain a presence in primary care, CVS Health accomplished that goal with a massive deal that could fortify its efforts to advance value-based payment in healthcare. The proposed $10.6 billion acquisition of Oak Street Health, a provider of senior-focused primary care, adds to a portfolio of assets that…

By Nick Hut February 28, 2023

In new final rule, CMS looks to claw back billions in overpayments to Medicare Advantage health plans

CMS has confirmed a new approach to its auditing of payments directed to Medicare Advantage health plans, but the agency says the regulatory burden on providers should not increase. A newly published final rule on risk adjustment data validation (RADV) establishes that CMS will use an extrapolation methodology to recoup overpayments to MA plans beginning…

By Nick Hut February 3, 2023

Healthcare News of Note: 100 hospitals receive funding for new physician residency slots to boost healthcare access

CMS distributed 200 Medicare-funded physician residency slots to 100 hospitals, aiming to bolster healthcare access in areas with a shortage of qualified professionals. Overall cancer mortality has dropped 33% since 1991, averting an estimated 3.8 million cancer deaths, according to the American Cancer Society’s latest report. Patients’ ratings of specialist care were markedly higher when…

By Deborah Filipek January 30, 2023

News Briefs: 2023 brings a steep fee hike for No Surprises Act arbitration cases

The No Surprises Act’s independent dispute resolution (IDR) process has become more expensive for healthcare stakeholders. For the new year, the nonrefundable administrative fee due from each party involved in any payment dispute that goes to arbitration increased from $50 to $350, according to a Dec. 23 memo from CMS’s Center for Consumer Information and…

By Nick Hut January 27, 2023
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