Finance & Reimbursement

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.

Medicare Inpatient Rule: Mandatory Bundled Payment Model

The Centers for Medicare and Medicaid Services (CMS) proposed the Transforming Episode Accountability Model (TEAM), which will hold selected hospitals accountable for the cost and quality of certain surgical procedures. TEAM aims to improve outcomes for Medicare patients undergoing certain high-volume surgical procedures while reducing Medicare spending.