Hospital Price Transparency: CMS Pushes for Standardization

R1 Regulatory Affairs & Regulatory Compliance TeamJanuary 3, 2024

In an era of increasingly expensive care, price transparency initiatives have become a significant aspect of the U.S. healthcare system. From the Transparency in Coverage (“TIC”) requirements for health insurers1  to the Good Faith Estimate requirements of the No Surprises Act (“NSA”) for scheduled services,2  ...

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A Perfect Storm: Agencies Collaborate on Medical Debt, Price Transparency, Charity Care

Kathryn Beard, JDAugust 17, 2023

Almost 40% of Americans recently reported they were deferring medical care due to the cost of treatment.1 This is particularly true for Americans with low incomes, who have reported cancelling treatment for even the most serious conditions due to an inability to pay for necessary services.

 

Financial ...

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Why Prior Authorization Reform Should Garner Provider Support

R1 Regulatory TeamApril 14, 2023

In the United States, prior authorization (“PA”) is a cost-containment tool utilized by payers to reduce payment for medically unnecessary or inappropriate patient care. Despite its laudable policy goals, the use of PA faces

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The Future of Good Faith Estimates Under the No Surprises Act

R1 Regulatory TeamJanuary 18, 2023

The No Surprises Act of the 2021 Consolidated Appropriations Act (“NSA”) established requirements for healthcare providers to deliver Good Faith Estimates (“GFEs”) for scheduled services or upon patient request. 

Key Takeaways: 

  1. Indefinite extension  of co-provider and co-facility enforcement ...

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Hospital Price Transparency: Lessons Learned, Best Practices

R1 Regulatory TeamDecember 19, 2022

Federal price transparency requirements for hospitals from the Centers for Medicare & Medicaid Services (CMS) provide patients with an unprecedented amount of insight into the costs for medical services.1  

 

In theory, more pricing information should ...

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RACMonitor: Why Too Much News is a Good Thing

Dr. Ronald HirschOctober 18, 2022

It is time for another multi-topic update. Some weeks produce just too much news to limit my reporting to one topic.

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RACMonitor: AMA Misses Opportunity to Simplify Hospital E&M Coding

Dr. Ronald HirschSeptember 25, 2022

AMA scores a hit with new guidelines; misses simplification of one subset of hospital E&M codes.

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RACMonitor: Medicare Advantage -- No Apparent Advantage for Some

Dr. Ronald HirschSeptember 16, 2022

Complaints are abundant from beneficiaries.

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RACMonitor: Patient Truly Ill? Why Random Audits Could Prevent Recoupment

Dr. Ronald HirschSeptember 9, 2022

Recently, the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) released an interesting audit. They audited billing of critical care visits by physicians who are employed by Lahey Clinic in Massachusetts. As usual, they planned to audit 100 admissions but then, as they describe, because of the ...

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RACMonitor: Shameless -- The Paradox of Healthcare Regulations

Dr. Ronald HirschAugust 18, 2022

Lots to report in this regulatory update.

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