Last Thursday, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a report that strongly suggests that Medicare Advantage (MA) plans delayed or denied medical treatments and procedures to beneficiaries that met the Medicare coverage requirements.
Analysts with the Office of the Inspector...CMS Rules
The No Surprises Act, a law that aims to protect Americans covered by private health plans from receiving surprise medical bills relating to emergency services or non-emergency services from out-of-network providers at in-network facilities, has been met with trouble since its implementation at the beginning of the year.
In February,...Arizona News
The American Hospital Association (AHA) announced its Health Equity Roadmap; a guide for hospitals and health systems to best remove structural barriers in health and become more equitable organization.
In its new guide, AHA pitches the new framework as a plan to meet organizations wherever they are in the process of creating a...
Medicare Advantage now manages the care for 45% of all Medicare beneficiaries, which demonstrates a +3% point improvement in penetration over 2021 and 9% increase in total enrollment year-over-year. Due to these rapidly increasing enrollment numbers, the program is dynamic and under regulatory scrutiny as it responds to patient...
On February 24, the U.S. Department of Health and Human Services (HHS) announced that it would release an additional $560 million in Provider Relief Fund (PRF) payments for healthcare providers who have reported losses due to the COVID-19 pandemic. The funds will be released by the Health Resources and Services Administration (HRSA) and...National News
As the national health care worker (HCW) shortage heightens, industry advocates and Congress are searching for solutions to the behavioral health crisis. From merging telehealth programs to increasing Medicaid reimbursement for youth behavioral health services, the field has an increasing number of complex issues that require...
In a public statement on January 27, 2022, the American Hospital Association (AHA), American Medical Association (AMA) and the American Nurses Association (ANA) urged as many people as possible to donate blood. The pandemic's impact has driven down donations in communities once relied upon for large donations just as the current surge...
The American Hospital Association (AHA) and American Medical Association (AMA) have sued the federal government over the implementation of the federal surprise billing law – specifically, a provision of a rule set to take effect January 1, 2022.
Both associations assert the provision ignores the No Surprises Act and would result...Arizona News
The Build Back Better Act (BBB) will be reviewed by Democrats in the Senate Finance and Health, Education, Labor and Pensions (HELP) committees this week, ahead of formal negotiations with the Senate parliamentarian over the "Byrd bath," a bipartisan meeting in which items from the budget reconciliation bill that do not directly impact...CMS Rules
On Tuesday, the Centers for Medicare and Medicaid Services issued a final rule for the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (PFS). The PFS includes policy changes for Medicare payments and Medicare Part B, and is the major mechanism for rate setting for the Medicare program as a whole. The PFS must remain budget...National News
On Tuesday, the Centers for Medicare and Medicaid Services (CMS) announced the final Outpatient Prospective Payment System (OPPS) rule for 2022. The final rule contains a substantial hike in the civil monetary penalty for hospitals not complying with price transparency rules, with a minimum $300 per day for hospitals with 30 or fewer...National News
A bipartisan group of senators, including Senators Kyrsten Sinema (D-AZ) and Mark Kelly (D-AZ), sent a letter to the Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure last Friday, warning against any potential cuts to the Medicare Advantage (MA) program. The letter comes as Democrats look for places to...National News
The pandemic put a damper on merger and acquisition (M&A) activity among hospitals. Now, looking forward, the question is whether such activity is a lifeline for a reeling industry or a greedy practice bad for everyday patients.
The consulting firm Ernst & Young’s (EY) Global Capital Barometer found global M&A...CMS Rules
The Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-term Care Hospital Prospective Payment System (LTCH) received a new final rule from the Centers of Medicare and Medicaid Services (CMS) this week. The rule helps providers by dropping a requirement that would have forced hospitals to disclose their contract terms...National News
A new bill introduced by Representatives Suzan DelBene (D-Wash.), Peter Welch (D-Vt.), Darin LaHood (R-Ill.) and Brad Wenstrup (R-Ohio) looks to reverese Trump-era modifications to the Medicare Accountable Care Organization (ACO) program and restore higher cost savings to participating providers while removing some of the risk. The bill...
Last Friday, the U.S. Supreme Court announced it would hear arguments for American Hospital Association v. Becerra, a case that deals with cuts made by the Centers for Medicare & Medicaid Services (CMS) to the 340B Discount Drug Program.
The American Hospital Association (AHA) along with the Association of American Medical...
On Monday, the Supreme Court declined to take up a lawsuit over the Trump administration Center for Medicare & Medicaid Services's (CMS) Medicare Part B pay cuts for outpatient clinic visits at off-campus hospital facilities. In February, the American Hospital Association (AHA), America's Essential Hospitals and the Association of...
Through the Health Resources and Services Administration, HHS released revised reporting requirements for recipients of Provider Relief Fund payments. The announcement includes expanding the amount of time providers will have to report information; the extension aims to reduce the burden on smaller providers.
On June 11, the Biden...
The nation's largest health insurer by membership announced a new policy to deter patients from seeking care in hospital emergency departments. UnitedHealthcare announced the change would take effect on July 1, and it would evaluate emergency room claims using "a number of factors" to determine whether or not the issue was truly an...National News
Last week, Senator Patty Murray (D., Wash.) and Representative Frank Pallone, Jr. (D., N.J.) released a letter asking for stakeholder input on a potential federal public health insurance option, commonly known as the public option. The request comes just as President Joe Biden unveiled his proposed budget for Fiscal Year 2022 in which he...
