Medicaid Reimbursement

Appeals Court Reinstates Changes to Medicaid DSH Payments Formula

by Jacqueline LaPointe

Hospitals that treat a large proportion of low-income and uninsured patients could face lower Medicaid disproportionate share hospital (DSH) payments following a recent appeals court decision. Earlier...

Medicaid DSH Payments Cover 51% of Uncompensated Care Costs

by Jacqueline LaPointe

Medicaid Disproportionate Share Hospital (DSH) payments covered about half of the uncompensated care costs incurred by qualifying hospitals nationwide in 2014, according to a Government Accountability...

13 States Still Struggle to Check Providers to Avoid Medicaid Fraud

by Jacqueline LaPointe

States are struggling to implement effective provider enrollment screening processes to prevent Medicaid fraud, including fingerprint-based criminal background checks, according to a recent HHS Office...

5 States Challenge Medicaid Payment Diversion Rule in Court

by Jacqueline LaPointe

California Attorney General Xavier Becerra is leading a multi-state effort to upend a new final rule from CMS that bars states from diverting Medicaid payments to third parties on behalf of providers,...

CMS Bans Diverting of Medicaid Payments to Home Health Unions

by Jacqueline LaPointe

A new final rule from CMS prohibits states from paying a portion of Medicaid payments for providers to third parties, including unions for home health workers. Released May 2, the Medicaid Provider...

Medicaid Expansion Improved Financial Stability for Health Centers

by Jacqueline LaPointe

Federally qualified health centers in Medicaid expansion states were significantly more likely to report financial stability and funding improvements since the implementation of the Affordable Care Act...

Documentation Issues Behind $23B in Medicare Improper Payments

by Jacqueline LaPointe

Medicare and Medicaid are on the Government Accountability Office’s (GAO) list of programs that are at an elevated risk for fraud, waste, abuse, and mismanagement after a recent investigation...

Hospitals Could Lose Up to $4.1B Under Medicaid Work Requirements

by Jacqueline LaPointe

Medicaid work requirements would reduce hospital revenue between $3.7 billion to $4.1 billion in 2019 alone, according to a recent analysis by the Commonwealth Fund. Hospitals in over a dozen states...

Slow Down Cuts to Medicaid DSH Payments, MACPAC Tells Congress

by Jacqueline LaPointe

The Medicaid and CHIP Payment and Access Commission (MACPAC) recently released its March 2019 report to Congress, which advises policymakers to roll out cuts to Medicaid disproportionate share hospital...

Hospital Cost Shifting Still Occurring in CO Despite Coverage Gains

by Jacqueline LaPointe

Despite higher Medicaid reimbursement, fewer uninsured individuals, and less uncompensated care costs, hospital cost shifting to commercial payers did not subside in Colorado. Those are the findings...

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...

Finding Medicaid Eligibility Cuts Hospital Bad Debt by 10%

by Jacqueline LaPointe

Extending insurance discovery efforts to insured patients can boost a hospital’s Medicare bad debt recovery by as much as ten percent annually, a new analysis shows. Identifying insured patients...

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...

CMS to Help Medicaid Reimburse for Maternal Opioid Misuse Care

by Jacqueline LaPointe

CMS recently announced that it will be awarding up to $64.6 million to 12 state Medicaid agencies to help develop Medicaid reimbursement and care delivery strategies for maternal opioid misuse...

Medicaid Could Save $4.8B Through Electronic Claims Management

by Jacqueline LaPointe

State Medicaid programs are significantly lagging with the adoption of fully electronic claim submissions, claim reimbursements, prior authorizations, and other claims management processes, according...

CMS OKs Medicaid Reimbursement for Substance Use Treatment in NH

by Jacqueline LaPointe

CMS recently approved a five-year Section 1115 demonstration allowing New Hampshire to provide Medicaid reimbursement to more behavioral health facilities for substance use disorder treatment...

CMS Aims to Protect Medicaid Payments to Providers, Not 3rd Parties

by Jacqueline LaPointe

CMS recently proposed a rule change that would prohibit a state from diverting Medicaid payments away from providers unless the payment arrangement is explicitly authorized by statute. The proposed...

NJ Passes Medicaid Reimbursement Cap on Non-Emergent ED Services

by Jacqueline LaPointe

Hospital emergency departments are one of the most expensive care settings, and New Jersey policymakers are trying to ensure providers only get paid for delivering emergency services to patients who...

CMS Boosting Audits to Combat Medicaid Fraud, Improper Payments

by Jacqueline LaPointe

In efforts to prevent Medicaid fraud and improper payments, CMS plans to increase the number of audits in the public healthcare program and optimize state-provided claims and provider data, according...