2024 Federal Poverty Guidelines Released

Payors and Providers wait for the release of the poverty guidelines each year to update patient financial assistance and eligibility information within their forms and systems. The 2024 Poverty Guidelines are now effective and posted HERE. Poverty guidelines are issued each year in the Federal Register by the Department of Health and Human Services (HHS). The federal poverty guidelines (FPG) are…

Read More

Is Strategic Pricing a Luxury or a Necessity for Hospitals Today?

  Hospitals are operating in a world where they are being crushed by labor costs.  I talk to CFOs daily that describe unsustainable labor models they have been forced into.  As a result of this financial stressor, hospitals must scrutinize other costs, looking for savings.  Hospitals must purchase sutures, oxygen, and other mission critical needs,…

Read More

Core Tenets for Monitoring and Improving Referring Relationships with Providers

Every hospital relies on a network of relationships with a variety of partners, including their patients and their support networks, local independent and employed physicians, state and federal organizations, payors, and many others. One of the most important relationships in driving growth, as opposed to other facility goals, is that with the local referring physician…

Read More

Price Standardization For Hospitals

Hospitals have a rational interest in standardizing prices across facilities.  This interest has only intensified with the introduction of Price Transparency requirements. The goal of standard pricing must be considered simultaneously with other goals such as price stability and changes in gross and net revenue. There are several complexities in this analysis that must be…

Read More

Federal Poverty Guidelines 2023 Release and the “Unwinding” of Medicaid Continuous Enrollment Period

Payors and Providers wait for the release of the poverty guidelines each year to update patient financial assistance and eligibility information within their forms and systems. The 2023 Poverty Guidelines are effective January 16, 2023, and are now posted HERE. Poverty guidelines are issued each year in the Federal Register by the Department of Health and Human Services…

Read More

New ESRD 2023 Payment Model and Dual Status Impact

Starting with the January 2023 payment month, health plans will see the impact of dual status on their End-Stage Renal Disease (ESRD) members change from prior years. In 2023, CMS implements the changes to the ESRD payment models that were announced in the 2023 advance notice. The revised ESRD payment model is calibrated on more…

Read More

ACA RA Transfer Report – 2021 Benefit Year

CLICK TO VIEW INTERACTIVE VISUALIZATION Once again, the U.S. Department of Health and Human Services (HHS) reported that the risk adjustment program operated smoothly for the 2021 benefit year. For the seventh year, the risk adjustment program is working as intended by more evenly spreading the financial risk carried by issuers that enrolled higher-risk individuals…

Read More

Dual Eligible Renewal Strategies

The U.S. Department of Health and Human Services (HHS) first declared a Public Health Emergency (PHE) in January 2020. Section 6008 of the Families First Coronavirus Response Act (FFCRA) as amended by the Coronavirus Aid, Relief, and Economic Security (CARES) Act provides states with a temporary 6.2 percentage point increase in their federal medical assistance…

Read More