surprise medical billing

CMS Clarifies Upcoming IDR Changes

Earlier this year, the departments of Health and Human Services, Labor, and the Treasury and the Office of Personnel Management published federal Independent Dispute Resolution operations final rules to improve the functioning of the No Surprises Act’s IDR process, which is part of a broader effort to eliminate surprise medical bills. The new rules seek to streamline communication between health care payers, providers, and certified IDR entities by establishing new timelines and processes. When the individual requirements in these final rules will take effect will vary depending on when the technical capacity to support them is ready within the not-yet-introduced [...]

joe2026-08-12T13:05:25-04:00August 13, 2026|Uncategorized|

Federal Health Policy Update for January 16

The following is the latest health policy news from the federal government for January 11-17. Some of the language used below is taken directly from government documents. Congress House Budget Committee Republican members of the House Budget Committee have circulated a list of possible policy changes that would reduce federal spending by between $5.3 trillion and $5.7 trillion over a period of ten years. Up to $3.4 trillion of those possible cuts could include reductions in federal health care spending. The health care cuts the document lists (all figures are ten-year reductions) are: Medicare introducing Medicare site-neutral outpatient payments - [...]

Federal Health Policy Update for February 22

The following is the latest health policy news from the federal government for February 16-22. Some of the language used below is taken directly from government documents. CMS and Medicaid DSH Payments CMS has published a final rule governing how third-party payers are factored into the calculation of hospitals’ Medicaid disproportionate share hospital-specific payment limit. This change requires that the calculation be based solely on Medicaid costs and payments and that costs and payments associated with dually eligible (Medicare and Medicaid) patients be excluded from the calculation of that limit. The effect of this change is that hospitals that are [...]

joe2024-02-22T22:00:03-05:00February 22, 2024|Alternative payment models, Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid regulations, Medicaid upper-payment limit, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

Providers Faring Well in Surprisingly Busy Dispute Resolution Process

Health care providers are winning more than three-quarters of all payment disputes being brought through an unexpectedly active federal Independent Dispute Resolution process. The process, created under the 2020 No Surprises Act to settle payment disagreements between providers and payers and to spare consumers surprise medical bills – especially for receiving emergency care from providers outside of their insurer’s network. 2023 saw 13 times more disputes during the first half of 2023 – nearly 300,000 cases in all – than federal officials anticipated. With more than 20 percent of the disputes submitted for resolution rejected as ineligible for the process, [...]

joe2024-02-20T21:23:48-05:00February 21, 2024|Uncategorized|

FEDERAL HEALTH POLICY UPDATE FOR THE WEEK OF SEPTEMBER 12-16

The following is the latest health policy news from the federal government for the week of September 12-16. Some of the language used below is taken directly from government documents. No Surprises Act The Department of Health and Human Services, the federal Office of Personnel Management, the Internal Revenue Service, the Department of the Treasury, the Department of Labor, and the Employee Benefits Security Administration have issued a request for information (RFI) seeking stakeholder comment on how to implement the No Surprises Act’s requirement that health care providers and payers give explanations of benefits and good-faith estimates of costs for [...]

iqtsupport2022-09-19T16:10:33-04:00September 19, 2022|340b, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC, Telehealth|

Federal Health Policy Update for Friday, July 30

The following is the latest health policy news from the federal government as of 2:45 p.m. on Friday, July 30. Some of the language used below is taken directly from government documents. Final Medicare Payment Regulations for FY 2022 CMS has published four final rules for Medicare payments in FY 2022: FY 2022 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, Hospice and Home Health Quality Reporting Program Requirements. (See also CMS’s fact sheet) FY 2022 Inpatient Psychiatric Facilities Prospective Payment System and Quality Reporting Updates for Fiscal Year Beginning October 1, 2021 (FY 2022) (See [...]

iqtsupport2021-07-30T16:33:45-04:00July 30, 2021|Centers for Medicare & Medicaid Services, Coronavirus, COVID-19, hospitals, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, post-acute care|

Federal Health Policy Update for Friday, July 2

The following is the latest health policy news from the federal government as of 2:45 p.m. on Friday, July 2. Some of the language used below is taken directly from government documents. Supreme Court The Supreme Court has announced that it will hear a case in its next term challenging cuts in 340B payments and another involving Medicare disproportionate share. White House The White House has posted a transcript of the July 1 press briefing given by its COVID-19 response team and public health officials. The transcript includes the announcement that the federal government will be launching surge response teams [...]

iqtsupport2021-07-05T22:53:55-04:00July 5, 2021|340b, Coronavirus, COVID-19, Medicare disproportionate share, Medicare DSH|