A recent Blue & Co. audit of a small hospital’s existing Managed Care contracts yielded an unfortunate surprise: a nearly twenty-year-old contract with a major insurance company with rates that […]
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President Biden’s administration recently announced its Path Out of the Pandemic action plan which included specific guidance around a COVID-19 vaccine mandate. The action plan calls for employers with 100 […]
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Pursuant to KRS 205.640 and managed care contracts, Kentucky Medicaid Managed Care Organizations (MCOs) are required to provide a Paid Claims Listings (PCLs) to all in-state hospitals. The department and […]
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The Volume Decrease Adjustment (VDA) is a lump sum payment available to Sole Community Hospitals (SCH) or Medicare Dependent Hospitals (MDH) who have experienced more than a 5% decrease in […]
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In this environment of uncertainty, it is important for hospitals to optimize all reimbursement opportunities while staying in compliance with Federal Regulations. One way that hospitals can identify additional reimbursement […]
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Medicare recently published updated bad debt regulations and the time is NOW to safeguard your Hospital’s reimbursement. Are you following proper guidelines to ensure you can write-off your Medicare/Medicaid crossover accounts? […]
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On September 2, 2020, CMS released its final ruling. It is effective beginning October 1, 2020, for FY 2021. This means it will go in to effect the first day […]
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Have you recently received Medicare bad debt audit adjustments that you felt were unfair? If so, you are not alone. MACs (Medicare Administrative Contractors) have been tightening their auditing standards and practices surrounding […]
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HRSA has indicated it will allow a hospital to accelerate timelines for its offsite locations to begin participating in the 340B Drug Discount Program. Previously, offsite locations were required to […]
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The White House Office of Management and Budget (OMB) approved the Centers for Medicare & Medicaid Services’ (CMS) plan, proposed September 30, 2019, to survey 340B hospitals for their net […]
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After more than a month of uncertainty and legal challenges, HRSA formally revokes the 340B rebate model pilot program and pledges additional guidelines if a future pilot program is pursued. […]
Congress has again postponed the next PAMA clinical lab reporting period. Hospitals and outreach labs should still prepare. The new guidelines moved the reporting window to May 1, 2026, through […]
A significant policy shift is about to reshape how hospitals structure, track, and bill for their off-campus Provider-Based Hospital Outpatient Departments (PB HOPDs). With the approval of Section 6225 of […]
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