Medicare DSH payments ruling could boost hospital reimbursement under 1115 waivers
Hospitals obtained a victory in a case about Medicare disproportionate share hospital (DSH) payments, with potentially significant reimbursement implications. In a July 27 ruling, a judge with the U.S. District Court for Northern Texas struck down an HHS rule that excluded certain patients from the DSH formula if they were covered through a Medicaid Section 1115…
Senate Medicaid hearing highlights the debate over federal spending cuts
Cuts to federal Medicaid spending are necessary to streamline the program and don’t necessarily portend tough times for providers, conservative policymakers and analysts argued during a Senate hearing. The Aug. 4 hearing of the Senate Budget Committee included discussion of whether healthcare policies in the One Big Beautiful Bill Act (OBBBA) should be scaled back…
CY 2027 Physician Fee Schedule Proposed Rule Summary Part III – Quality Payment Program
HFMA presents Part III of three detailed summaries of the proposed rule relating to the Medicare physician fee schedule for CY 2027 and other revisions to Medicare Part B policies.
CY 2027 Physician Fee Schedule Proposed Rule Summary Part II – MSSP Requirements
HFMA presents Part II of three detailed summaries of the proposed rule relating to the Medicare physician fee schedule for CY 2027 and other revisions to Medicare Part B policies.
SUSTAIN 340B Act proposes major changes for hospitals and pharmacies
A bipartisan working group in Congress released a preliminary legislative draft that attempts to resolve some of the most disputed aspects of the 340B Drug Pricing Program. One noteworthy provision in the legislation would curtail the 340B rebate model, which was finalized by the Health Resources and Services Administration on July 31 and is scheduled to begin Jan.…
CJR-X mandatory bundled payment model begins for hospitals in 2028
Hospitals have 17 months to prepare for the first mandatory nationwide alternative payment model, as established in Medicare’s FY27 final rule for the Inpatient Prospective Payment System (IPPS) and long-term care hospitals (LTCHs). The final rule makes no major changes to the proposal issued earlier this year for the CJR-X Model, which will require most…
How hospitals can prepare for heightened 340B oversight
Momentous change may be looming for the 340B Drug Pricing Program, currently managed by the Health Resources & Services Administration (HRSA). An ongoing debate regarding the program’s effectiveness reflects broad concerns regarding transparency, oversight and program integrity. At the center of the debate are questions about implementation of HRSA’s 340B Rebate Model Pilot Program. Although…
Frictionless payment, post-claim resolution and the move to value
HFMA Senior Editor Erika Grotto shares conversations with three sponsors from HFMA’s Annual Conference. This episode includes: * Adam Cartabiano from Knowtion Health talking about post-claim resolution and AI in the revenue cycle. * Jessica Gerow from Zelis discussing payment modernization that goes beyond ACH. * Jeffrey Palmieri and Cindy Clark from Huntington Bank share…
The State of Payer Negotiations: Data, Visibility and Financial Performance
Drawing on responses from 161 provider organizations, this report benchmarks how healthcare leaders are approaching payer negotiations and reimbursement management. Download this white paper to review opportunities to improve visibility, strengthen financial performance, and make better-informed contracting decisions.
New data on No Surprises Act IDR cases show providers won often in 2025
Providers and their intermediaries continued to flourish in the No Surprises Act’s independent dispute resolution (IDR) process during the second half of 2025, according to newly released data from the federal departments overseeing IDR. Among 1.15 million disputes that received payment determinations during the six-month period, providers won 85%. That share generally tracked trends seen…