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.
CHA Encourages Members to Participate in the Vitality Index Payer Scorecard
What’s happening: CHA is endorsing member participation in the Vitality Index Payer Scorecard, which will provide critical information to support CHA’s advocacy to hold insurers accountable for timely and accurate reimbursement.
What else to know: The CHA Board of Trustees has endorsed this tool, which will automatically draw de-identified claims and remittance information from hospitals without requiring additional reporting or surveys.
CMS Announces Flexibilities for Providers Impacted by Change Healthcare Hack
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued a statement outlining the flexibilities it is offering to providers impacted by the Change Healthcare data breach.
What else to know: CHA is closely following this issue and will provide updates on additional steps CMS is taking as they become available.
CMS Releases Data on No Surprises Act Payment Disputes
What’s happening: The Centers for Medicare & Medicaid Services released publicly available independent dispute resolution (IDR) reports for the first two quarters of reporting year 2023.
What else to know: The report includes certain data submitted by disputing parties and certified IDR entities to the No Surprises Act (NSA) federal IDR portal.
CMS Finalizes Medicaid DSH Third-Party Payment Calculation
What’s happening: The Centers for Medicare & Medicaid Services finalized changes to how states calculate the hospital-specific cap for Medicaid disproportionate share hospitals (DSH).
What else to know: The rule is effective April 23.
CHA Provides Updated Federal Quality Measures Matrix
What’s happening: CHA has updated its federal quality measures matrix to reflect the 2024 federal fiscal year and calendar year Medicare prospective payment system final rules.
What else to know: The matrix includes quality measures required for public reporting and performance-based programs for hospitals and post-acute care providers.
CHA Will Host Vitality Payer Scorecard Webinar
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What’s happening: CHA is hosting a complimentary, members-only webinar on Feb. 27 at 10 a.m. (PT) to highlight the American Hospital Association Vitality Payer Scorecard, which was recently endorsed by the CHA board.
What else to know: The scorecard captures necessary and normalized data points without sharing protected health information. The automated process is based on de-identified claims and remittance files and eliminates the need for CHA surveys on this issue.
CHA DataSuite Released Medicare Hospital FFY 2025 Wage Index and Occupational Mix Revised Data Analysis
What’s happening: CHA DataSuite has issued a hospital-specific analysis of the Medicare hospital federal fiscal year (FFY) 2025 wage index and occupational mix data.
What else to know: The data has been revised and is the second of three wage and occupational mix data public use files (PUFs) that the Centers for Medicare & Medicaid Services (CMS) issued to develop the hospital wage index for FFY 2025.
CHA Will Host 2024 Hospital Finance and Reimbursement Seminar
What’s happening: CHA will host a one-day seminar on March 11 (Sacramento) and 13 (Burbank) at 8 a.m. to discuss how Medicare, Medi-Cal, and other hospital reimbursements will be impacted by the state and federal regulatory environment, recently enacted and anticipated policies, and the new Office of Health Care Affordability (OHCA).
What else to know: The program will discuss key policies, challenges, and opportunities. Registration is open.
CMS Issues Advance Notice of Proposed Medicare Advantage Payment Changes
What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued advance notice of proposed changes to Medicare Advantage (MA) Part C and Part D payments for calendar year 2025.
What else to know: Comments are due to CMS by 2 p.m. (PT) on March 1.
CHA DataSuite Releases Analysis of the Quality Program Measure Trends for Third Quarter 2023
What’s happening: CHA DataSuite issued a hospital-specific analysis for the quality program measure trends with an updated third quarter 2023 Care Compare data release.
What else to know: The measures updated in this release are hospital consumer assessments of health care providers and systems, safety, outcomes, readmissions, and star ratings. The Centers for Medicare & Medicaid Services adopted a sepsis measure to be evaluated under the federal fiscal year 2026 Value-Based Purchasing (VBP) Program, which is included in this analysis.