Hospital Payments and Operations
IHA summarizes and analyzes federal policies impacting hospital payments and operations.
New MA Appeals Provider Complaint Process
CMS has revised the complaint process provider organizations should use to submit complaints related to Medicare Advantage claim disputes and plan appeals.
Recording: Hospital Wage Index: Maximizing Medicare Reimbursement (5.9.24)
This webinar walks IHA members through the wage index development process, the impact of recent court cases and policy changes, and the opportunities before hospitals. Password: pDtV3mRA
340B ADR Final Rule
HRSA published a final rule revising the 340B ADR process required under the Affordable Care Act.
Recording: CMS Interoperability and Prior Authorization Final Rule (4.3.24)
CMS provided IHA members with an overview of the interoperability and prior authorization final rule (CMS-0057-F). Password: pMtq3rug
CMS Final 340B Payment Remedy
CMS finalized a payment remedy in response to underpayments to 340B hospitals from 2018 through 2022.
Medicare Advantage Final Rule Implementation Handbook
The American Hospital Association developed this implementation guide to help equip hospitals and health systems with tools to better advocate for MA plan compliance with regulatory requirements.
2023 Medicare Behavioral Health and Telehealth Fact Sheet
This fact sheet summarizes several behavioral health and telehealth policies implemented via CY 2023 Medicare payment rules.
Medicare Quality Programs Reference Guide
This reference guide includes details for the 2023, 2024, and 2025 Medicare Value-Based Purchasing, Readmissions Reduction, and Hospital-Acquired Condition Reduction programs.
Overview of Medicare RRP and HAC Programs
An IHA webinar on June 9 provided an overview of the Medicare Readmissions Reduction Program (RRP) and Hospital Acquired Condition (HAC) Program. A recording of the webinar is available here.
Webinar: Top Medicare Reimbursement Opportunities Post COVID
An IHA webinar on May 17 identified strategies to enhance Medicare reimbursement. Access the webinar recording here (password Ehc6efgf). Click "Read More" below for the program slides.
Overview of Medicare VBP Program
An IHA webinar on May 16 provided an overview of the Medicare Value Based Purchasing (VBP) Program, which is the only Medicare quality program to recognize improvement as well as achievement.
Federal No Surprises Act Implementation
IHA shares concerns on the No Surprises Act, which outlined new patient protections from surprise medical bills and requirements for healthcare providers and health plans.
CMS Releases Guidance for Electronic ADT Notification CoP
CMS issued interpretative guidance concerning the Interoperability and Patient Access final rule electronic admission, discharge and transfer notification Conditions of Participation.
Updated Electronic ADT Enforcement Date and ONC Information
The implementation and enforcement deadline for new electronic admission, discharge and transfer notifications tied to Medicare Conditions of Participation is May 1, 2021.
May 1 Implementation Deadline: Electronic Exchange of Patient ADTs as Medicare CoP
As part of Medicare Conditions of Participation, hospitals, psychiatric hospitals and critical access hospitals must send electronic patient admission, discharge and transfer information by May 1.
March 29 Deadline: Apply for IME and DGME FTE Slots
Teaching hospitals have until March 29 to apply for IME and DGME slots made available by the recent closure of two teaching hospitals.
Upcoming Deadlines: Medicare Quality Program Reporting and Reweighting Extensions
Hospitals and clinicians may apply for quality data reporting exceptions due to COVID-19. See an IHA memo with deadlines and additional information.
FFY 2021 Medicare Bad Debt Policy Changes
CMS clarified and codified longstanding Medicare bad debt policy via the FFY 2021 IPPS final rule. See IHA's fact sheet on the recent policy changes.
Delayed Due Dates for Medicare Cost Reports
CMS delays the due date for several upcoming cost report submissions.
HHS OIG Work Plan, 2020
IHA closely monitors the OIG Work Plan to keep our members informed about potential changes to the healthcare landscape. This document summarizes current OIG studies members may find most pertinent.
CLFS PAMA Reporting Period Changes
CMS delayed the private payer data reporting period for CDLTs from applicable laboratories, including hospital outreach laboratories, as required under the Protecting Access to Medicare Act of 2014.
Final Rule: Changes to Medicare Conditions of Participation
On Sept. 30, the Centers for Medicare & Medicaid Services (CMS) published in the Federal Register (FR) a final rulemaking a series of changes to the Medicare conditions of participatio n(CoP).
Final Rule: Revised Discharge Planning Requirements for Hospitals
On Sept. 30, CMS published a final rule modifying discharge process requirements as a condition of participation for hospitals, critical access hospitals (CAHs) and home health agencies (HHAs).
Proposed Specialty Care Models: Radiation Oncology and End-Stage Renal
On July 18, CMS published in the Federal Register (FR) two proposed specialty care models specific to radiation oncology and end-stage renal disease (ESRD).