Out-of-network pricing lawsuits test MultiPlan, Zelis business models
Antitrust lawsuits brought by healthcare providers against insurers and two of their contracted platforms are proceeding with high stakes, although the road to a final outcome will be long. Billions of dollars and implications for the business models of insurers and pricing vendors are on the line in litigation against MultiPlan (now known as Claritev)…
FY 2027 Skilled Nursing Facility PPS Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule updating for FY 2027 the Medicare skilled nursing facility (SNF) payment rates, SNF Quality Reporting Program and the SNF Value-Based Purchasing Program.
FY 2027 Hospice Payment Rate Update Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule updating the Medicare hospice payment rates, wage index and Hospital Quality Reporting Program for FY 2027.
Medicare payment policy changes for 2027: Key signals from Kennedy hearings
Amid ample rancor, some of the rhetoric during congressional appearances Thursday by HHS Secretary Robert F. Kennedy Jr. had substantive implications for healthcare industry stakeholders. During two House hearings to discuss his department’s proposed FY27 budget, Kennedy and members of the Ways and Means Committee and a subpanel of the Appropriations Committee touched on a…
FY 2027 Inpatient Psychiatric Facilities PPS Proposed Rule Summary
HFMA presents a detailed summary of the FY 2027 Inpatient Psychiatric Facilities Prospective Payment System proposed rule, published in the April 7, 2026, Federal Register.
CMS FY27 rule expands bundled payments, adjusts Medicare inpatient reimbursement rate
For the first time, a value-based payment model is set to become mandatory for almost all hospitals nationwide. The expansion of the Comprehensive Care for Joint Replacement (CJR) bundled payment model is a headlining provision of the newly released Medicare FY27 proposed rule for hospital inpatient services and long-term care hospitals (LTCHs). Also in the…
FY 2027 Inpatient Rehabilitation Facility PPS Proposed Rule Summary
HFMA presents a detailed summary of the FY 2027 proposed rule updating the Medicare inpatient rehabilitation facility prospective payment system.
In a first, a drugmaker’s lawsuit challenges HRSA’s 340B patient definition
In a new chapter for litigation involving the 340B Drug Pricing Program, a drugmaker is suing the federal government over the definition of patient as it pertains to the program. AbbVie Inc. says the definition established by the Health Resources and Services Administration (HRSA) in 30-year-old guidance is unwieldy and enables inappropriate access to 340B…
Medicare Advantage 2027 payment update increases after a CMS revision
Belying earlier projections, CMS gave Medicare Advantage (MA) health plans a payment hike for 2027. Payments will increase by 2.48%, or more than $13 billion, according to a final rate notice published April 6. It’s a better outcome for stakeholders than was anticipated when CMS released the advance rate announcement in January. Then, the payment…
Trump’s FY27 HHS budget proposal outlines cuts, operational changes
President Donald Trump’s healthcare budget proposal for FY27 emphasizes Making America Healthy Again (MAHA) priorities and slashes operational costs within HHS. At $111.1 billion, total HHS funding would decrease by $15.8 billion, or $12.5%, relative to FY26. When counting onetime recissions, the effective cut would be nearly $23 billion (from $112.3 billion in FY26 to…