Policy & Regulation

Study: Safety-Net Hospitals Miss Out on Some Medicaid DSH Payments

by Jacqueline LaPointe

Over a third of Medicaid disproportionate share hospital (DSH) payments may have been misallocated, according to a study led by Weill Cornell Medicine and University of Pennsylvania investigators. The...

Providers Leaving No Stone Unturned to Stop Medicare Payment Cuts

by Jacqueline LaPointe

Healthcare industry groups representing over 1 million physicians and other clinicians have joined together to urge Congress to prevent a 4.5 percent Medicare payment cut starting Jan. 1,...

Payment Rate Policies Contributed to Lower Medicare Spending Growth

by Victoria Bailey

Changes in Medicare payment policies and varying beneficiary characteristics drove the reduction in Medicare spending growth over the last decade, according to a study published in JAMA Health...

HHS Gives Providers More Time for Good Faith Estimate Compliance

by Jacqueline LaPointe

HHS has extended enforcement discretion for the delivery of some good faith estimates (GFEs) under the No Surprises Act, according to new guidance. The guidance released by HHS on Friday says that CMS...

HHS Proposes Changes to 340B Administrative Dispute Resolution

by Victoria Bailey

HHS has proposed revisions to the 2020 final rule on the 340B Administrative Dispute Resolution (ADR) process to modify policy and operational challenges. The ADR process in the 340B Drug Pricing...

House Committee Requests Changes to Final Surprise Billing Rule

by Victoria Bailey

Leaders of the House Committee on Ways and Means have voiced concerns that the final surprise billing rule on the independent dispute resolution (IDR) process continues to violate the No Surprises...

NY Gov. Signs Legislation Prohibiting Property Liens Over Medical Debt

by Victoria Bailey

New York Governor Kathy Hochul has signed legislation aiming to protect patients with medical debt from facing wage garnishment or liens on their property. “No one should face the threat of...

22 States Want CMS to Repeal Healthcare Vaccine Mandate

by Jacqueline LaPointe

The healthcare vaccine mandate from CMS is no longer needed, according to attorneys general from nearly half the states. A coalition of attorneys general from 22 states have filed a petition under the...

KFF: Varying Hospital Charity Care Policies Influence Spending

by Victoria Bailey

Half of all hospitals reported spending 1.4 percent or less of their operating expenses on charity care in 2020, but spending varied due to different state-level charity care policies, according to...

CMS Settles on Physician Fee Schedule Conversion Factor Cut of $1.55

by Jacqueline LaPointe

UPDATED 11/02/2022: CMS has released the Calendar Year (CY) 2023 Physician Fee Schedule (PFS) final rule, which will reduce the conversion factor while expanding access to behavioral health and...

OPPS, ASC Final Rule Boosts Medicare Reimbursement by 3.8%

by Victoria Bailey

UPDATED 11/02/2022 at 10:00 AM EST: The Calendar Year (CY) 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule from CMS has...

CMS Finalizes Medicare Reimbursement Increase for ESRD Facilities

by Victoria Bailey

CMS has finalized a 3.1 percent increase in Medicare reimbursement for end-stage renal disease (ESRD) facilities in the Calendar Year (CY) 2023 ESRD Prospective Payment System (PPS) final...

Home Health Agencies Get $125M Payment Boost from Medicare

by Jacqueline LaPointe

Home health agencies will receive a 0.7 percent Medicare payment boost under the calendar year (CY) 2023 Home Health Prospective Payment System (HH PPS) Rate Update final rule, translating to an extra...

Some State Surprise Billing Resolution Processes Favor Providers

by Jacqueline LaPointe

The No Surprises Act gives states the opportunity to enforce surprise billing provisions, but most are leveraging the federal independent dispute resolution process to determine out-of-network rates,...

Practices Most Frustrated With Prior Auths, Then No Surprises Act

by Jacqueline LaPointe

Prior authorizations are still the top regulatory burden according to executives from group practices, while No Surprises Act compliance has debuted on the list this year as the second most burdensome...

CMS Seeks Input on National Directory of Healthcare Providers

by Jacqueline LaPointe

CMS is looking for stakeholder feedback on establishing the first, national directory of healthcare providers and services, according to an unpublished Federal Register notice. In the request for...

SCOTUS Won’t Hear Healthcare Vaccine Mandate Case Again

by Jacqueline LaPointe

The Supreme Court has declined to hear a challenge of the healthcare vaccine mandate brought on by 10 states claiming the mandate is an overreach of the federal government’s power over states and...

TX Doctors Sue Feds Over Surprise Billing IDR Process, Again

by Jacqueline LaPointe

The Texas Medical Association (TMA) is once again suing the federal government over the surprise billing law enacted earlier this year. TMA sued federal regulators and won last year. At the time, the...

CMS Delays Radiation Oncology Model With No New Start Date

by Jacqueline LaPointe

The Radiation Oncology Model has been delayed indefinitely under a final rule released by CMS on Thursday. The alternative payment and care delivery model for cancer care aims to improve quality of...