About Finance & Reimbursement
California’s hospitals are under duress, facing crippling inflation and systemic underfunding by government payers — Medi-Cal and Medicare. Every day, over half of California’s hospitals lose money caring for patients. The 2023-24 state budget reauthorizes California’s managed care organization tax, dedicating much of the revenue to support for Medi-Cal enrollees. But without meaningful change to Medicare and Medi-Cal, the most vulnerable Californians will continue to be left behind. Health insurance companies must also do their part to protect essential services, including timely reimbursement and processing of claims. reimbursement and processing of claims.
Prepare to Display New Hospital Price Transparency Data in CMS Templates
What’s Happening: The Centers for Medicare & Medicaid Services (CMS) has released resources on the newly finalized price transparency machine readable file (MRF) requirements.
What Else to Know: Hospitals have until July 1, 2024, to comply.
DataSuite Analysis Discusses Outpatient Payment Changes for 2024
What’s Happening: CHA DataSuite has issued a hospital-specific analysis of the calendar year (CY) 2024 Medicare outpatient prospective payment system final rule.
What Else to Know: The analysis shows providers how Medicare outpatient fee-for-service payments will change from CY 2023 to CY 2024 based on the policies set in the final rule.
DataSuite Analysis Discusses Readmissions Reduction Program for 2024
What’s Happening: CHA DataSuite has issued a hospital-specific analysis of the federal fiscal year (FFY) 2024 readmissions reduction program (RRP).
What Else to Know: The analysis provides detailed performance information on the readmissions measures that are currently evaluated under the Medicare hospital RRP.
Summary: Details of Final Outpatient Payment Rule
What’s Happening: A comprehensive summary of the finalized payment updates and policy changes to the Medicare outpatient prospective payment system for calendar year 2024 is available.
What Else to Know: The provisions are generally effective Jan. 1, 2024.
Updated Guide on Final Rule Implementation Now Available
What’s happening: A members-only guide from the American Hospital Association to support hospitals in the implementation of the Medicare Advantage (MA) final rule is now available for calendar year 2024.
What else to know: The document provides a summary of key provisions of the final rule, which seeks to align MA coverage with traditional Medicare more clearly and to increase oversight of MA plans.
Return Hospital Engagement Letters for Area Wage Index Litigation by Dec. 8
What’s happening: Dec. 8 is the deadline for hospitals to sign up for a CHA-supported legal challenge to Medicare’s low-wage index policy.
What else to know: An updated analysis increases the estimated impact of these policies on California hospitals from $26 million to $33 million in federal fiscal year (FFY) 2024.
Hear From DataGen About the Outpatient Payment Final Rule
What’s Happening: A DataGen webinar on Dec. 5 at noon (PT) will provide an overview of the calendar year 2024 outpatient prospective payment system final rule. What Else to Know: Registration is required.
Summary: Providers Would Face Financial Penalties for Information Blocking
What’s happening: A members-only summary from Health Policy Alternatives, Inc., of the proposed rule on information blocking details provider disincentives related to programs from the Centers for Medicare & Medicaid Services.
What else to know: Comments on the proposed rule are due Jan. 2.
Continuing Resolution Averts Government Shutdown and Delays DSH Cuts
What’s happening: The House voted 336-95 on a two-tiered stopgap measure that funds the federal government past the Nov. 17 deadline and delays Medicaid disproportionate share hospital cuts until Jan. 19. The Senate passed the measure on Nov. 15 and President Biden has indicated he will sign it.
What else to know: Funding expires for certain federal agencies on Jan. 19 and other agencies on Feb. 2.