Reimbursement

The AHA and American Society of Health-System Pharmacists Nov. 14 urged House and Senate leaders to oppose any policies that fail to take into account the costs of safely providing drug administration services to the complex patients that hospitals serve.  
The Centers for Medicare & Medicaid Services (CMS) on Nov. 1 posted its calendar year (CY) 2023 outpatient prospective payment system (OPPS)/ambulatory surgical center (ASC) final rule. The rule increases OPPS rates by a net 3.8% in CY 2023 compared to 2022.
The United States District Court for the District of Columbia ruled in favor of the AHA, holding that HHS must immediately halt the departments’ unlawful cuts to outpatient reimbursement rates for the remainder of 2022 for certain hospitals that participate in the 340B Drug Pricing Program. 
It is broadly acknowledged that Medicare reimburses hospitals less than the cost of providing care and their reimbursement rates are non-negotiable.
Anthem, the country’s second-biggest health insurance company, is behind on billions of dollars in payments owed to hospitals and doctors because of onerous new reimbursement rules, computer problems and mishandled claims, says a Kaiser Health News article that is spotlighted in USA Today.
The mission of each and every hospital in America is to serve the health care needs of the people in its community 24 hours a day, seven days a week. But, hospitals’ work is made more difficult by our fragmented health care system — a system that leaves millions of people unable to afford the…