United States

Health care industry issues and insights webcast series: Part 1 recap

Regulatory update: Timely topics to consider

INSIGHT ARTICLE  | 

What are the key regulatory provisions affecting health care organizations’ revenue streams? In our first webcast in the Health care industry issue and insights series, presenters focused on:

  • Medicare inpatient prospective payment system (IPPS) rate updates
  • National cost/charge ratio (CCR)
  • Medicare disproportional share hospitals (DSH) and urgent care centers (UCC)
  • 340B drug discount program
  • And more

Key takeaways from the presentation include:

  • Drivers to consider for IPPS include, but are not limited to:
    • Revenue integrity improvements
    • Financial and cost reporting opportunities
    • Wage index and geographic classifications
    • Proper matching of costs, charges and program charges
    • Special payment provisions applicable to specific provider situations
  • Understanding how national CCRs may be different from facility-specific CCRs:
    • Using this information to evaluate facility-specific pricing strategy beyond Medicare
    • When developing new or unique ancillary cost centers, implement accurate cost finding (i.e. MRI and CT split from radiology)
  • Relating to DSH, hospitals must qualify for traditional DSH status in order to receive UCC payments. There is continued emphasis on a thorough process to capture all eligible Medicaid days, including health maintenance organziation and expansion; traditional DSH remains a significant Medicare administrator contractor audit focus area and subject to litigation
  • CMS will not use S-10 data for 2018 payment determinations, most likely not to be implemented until 2021
  • The 340B provides significant opportunities for savings for safety-net providers; however, the program is complex and continues to present challenges for program owners

For more information, watch the webcast. In addition, learn how we can help you with your compliance challenges by checking out our regulatory recovery services

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RECORDED WEBCAST

Health care industry issues and insights webcast series

  • November 17, 2016

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