Hospital Reimbursement

Hospitals Seek Another Delay for $4B Medicaid DSH Payment Cut

by Jacqueline LaPointe

America’s Essential Hospitals, American Hospital Association (AHA), Association of American Medical Colleges (AAMC), and five other national hospital groups are calling on policymakers to...

More Hospitals Sue HHS Over Outpatient Site-Neutral Payments

by Jacqueline LaPointe

Thirty-eight hospitals filed a lawsuit against HHS over a $380 million reduction in Medicare reimbursement to hospitals under a new outpatient site-neutral payment policy. The lawsuit alleges that HHS...

Claims Management Automation Progresses, But Opportunities Remain

by Jacqueline LaPointe

Electronic claims management adoption by plans and providers is at or above 80 percent for three of the seven transactions analyzed in the most recent CAQH Index. The CAQH 2018 Index showed adoption...

Are Hospital Readmissions Reduction Program Results Overstated?

by Jacqueline LaPointe

CMS, researchers, and other healthcare stakeholders have touted the Hospital Readmissions Reduction Program (HRRP) touted as a success. Under the authority of the Affordable Care Act, CMS launched the...

Medicare, Medicaid Reimbursement $76.8B Under Hospital Costs

by Jacqueline LaPointe

The largest public payers continue to underpay hospitals, data from the most recent American Hospital Association (AHA) Annual Survey of Hospitals revealed. Medicare and Medicaid reimbursement fell...

Opioid Overdose Care Totals $1.94B in Annual Hospital Costs

by Jacqueline LaPointe

The opioid crisis is hitting hospital costs, a recent analysis by healthcare improvement company Premier uncovered. Approximately $1.94 billion in annual hospital costs were attributable to patients...

Hospitals Weigh in on Medicare DSH Payment Supreme Court Case

by Jacqueline LaPointe

Major hospitals and medical colleges recently urged the Supreme Court to affirm a DC Circuit Court decision that HHS violated the Medicare Act when the department altered the reimbursement adjustment...

HHS Overstepped Authority with 340B Reimbursement Cuts, Judge Rules

by Jacqueline LaPointe

A federal judge in Washington DC recently struck down a nearly 30 percent reduction in 340B reimbursement cuts. US District Judge Rudolph Contreras ruled that HHS Secretary Alex Azar exceeded his...

Hospital Wage Data Inaccuracies Led to Medicare Reimbursement Issues

by Jacqueline LaPointe

CMS may not be appropriately adjusting Medicare reimbursement to hospitals for local labor prices, a new HHS Office of the Inspector (OIG) report reveals. The HHS watchdog found “significant...

CMS Paid $4M in Excess GME Medicare Reimbursement, OIG Finds

by Jacqueline LaPointe

Audits performed by the HHS Office of Inspector General (OIG) showed that hospitals received excess Graduate Medical Education (GME) Medicare reimbursement after counting residents and interns as more...

More Site-Neutral Payments to Impact Value-Based Care, Reps Says

by Jacqueline LaPointe

Over 130 members of the House of Representatives recently urged CMS to reconsider a proposed expansion of site-neutral payments to grandfathered off-campus provider-based hospital departments in...

200 Hospitals Face 5.5% Medicare Payment Cut Under Site-Neutral Rule

by Jacqueline LaPointe

About six percent of hospitals subject to the Medicare Outpatient Prospective Payment System (OPPS) would be disproportionately impacted by a recent proposal to expand site-neutral Medicare payments, a...

Medicare DSH Payment Case Makes Its Way to the Supreme Court

by Jacqueline LaPointe

The Supreme Court recently agreed to review an appeal on a case that could affect up to $4 billion in Medicare Disproportionate Share Hospital (DSH) payments. Supreme Court judges approved a request...

Federal Policies to Decrease Hospital Payments by $218B by 2028

by Jacqueline LaPointe

Several federal policies since 2010 will reduce hospital payments by a total of $218.2 billion by 2028, a new report from the health economics consulting firm Dobson | DaVanzo and Associates...

CMS OKs Maryland’s All-Payer Alternative Payment Model Expansion

by Jacqueline LaPointe

CMS greenlighted an expansion of an all-payer alternative payment model in Maryland that allows the state to set hospital reimbursement rates, the office of Governor Larry Hogan recently...

Maximizing Provider Revenue with Payer Contract Management

by Jacqueline LaPointe

Ensuring correct reimbursement in a timely manner is always at the top of a healthcare provider’s mind. But many provider organizations could be leaving money on the table with inefficient and infrequent payer contract...

Medical Prices Grew 28% for Hospital E&M Services Since 2012

by Jacqueline LaPointe

Medical prices for hospital evaluation and management (E&M) services rose 28 percent and allowed amounts increased 26 percent between May 2012 and 2017, the most recent FH Medical Price Index from...

Fewer Hospitalizations Reduced Skilled Nursing Facility Use by 15%

by Jacqueline LaPointe

Skilled nursing facility (SNF) utilization has declined 15 percent from 2009 to 2016, a new Avalere analysis revealed. The analysis of Medicare fee-for-service claims revealed that SNF utilization...

MO Court Bans CMS from Altering DSH Medicaid Reimbursement Rules

by Jacqueline LaPointe

A District Court in Missouri prohibited CMS from enforcing a 2017 final rule and two Frequently Asked Questions (FAQs) from 2010 that would alter the formula for calculating hospital-specific limits...