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.

CMS Update on 2025 OPPS and PFS Proposed Rules

On July 10, the Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2025 outpatient prospective payment system (OPPS) proposed rule and physician fee schedule (PFS) proposed rule.

CHA is hosting this members-only webinar to discuss key proposals in these proposed rules ahead of the comment deadline.

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.