CMS details implementation of Medicaid 6-month eligibility checks under the OBBBA
CMS has issued guidance on how Medicaid expansion states should implement the higher-frequency eligibility redeterminations as required under the One Big Beautiful Bill Act (OBBBA). Starting in 2027, states must conduct eligibility checks of most adults in the expansion population every six months, up from annually (the guidance refers to the 2025 law as the…
Hospitals urged to strengthen cybersecurity amid rising Iran-linked threats
Hospitals are among the organizations that should pay special attention to ensuring their cybersecurity is shored up amid the ongoing conflict in Iran, according to federal agencies. Iran-linked cyber actors have targeted U.S. critical infrastructure at other times in recent years, and the recent attacks on the country by Israel and the United States may…
Hospitals can use 2026 to prepare for CMS TEAM bundled payment risk
In what amounts to a dress-rehearsal year, hospitals participating in CMS’s mandatory Transforming Episode Accountability Model (TEAM) should take the opportunity to prepare for the high stakes that loom. TEAM, a five-year bundled payment model that is obligatory for nearly 750 hospitals in 188 selected markets, is upside-only in its first year. The ante rises…
Medicare claims processing modernization gains urgency at CMS
In 2025, the newly created U.S. Department of Government Efficiency (DOGE) was associated with the large-scale culling of staff and a proposed restructuring at HHS, along with substantial reductions in personnel at many other departments. These days, in addition to releasing a massive file of provider-level Medicaid billing data, DOGE is placing its healthcare focus…
How to use an enterprise approach in implementing AI in RCM
Revenue cycle transformation has long been framed as a matter of technological advances. But in the AI-fueled era, the differentiator is shifting from individual technologies to enterprise operating model redesign, according to leaders from Mayo Clinic and Jefferson Health. They described how their organizations are repositioning revenue cycle as a core component of care delivery,…
DOGE releases Medicaid billing data to expand fraud oversight
The Trump administration’s ongoing push to address fraud in government healthcare programs includes the release of a massive data set showing Medicaid billing patterns of individual providers. With more than 227 million rows of Medicaid fee-for-service and managed-care billing data and roughly 1.8 million national provider identifiers (NPIs), the file shows the NPI for each…
Study details how OBBBA Medicaid cuts will restructure state budgets
A handful of states may gain financially because of the Medicaid provisions legislated in the 2025 reconciliation bill known as the One Big Beautiful Bill Act (OBBBA), according to a new study. Results of an analysis by RAND Health include the finding that state Medicaid budgets will fall by $664 billion between 2025 and 2034,…
GAO examines No Surprises Act payment and network trends
Recent trends seen as a consequence of the No Surprises Act (NSA) include a moderate increase in the share of providers going in-network for some services, according to a report by the Government Accountability Office (GAO). Such a development was a secondary goal of the 2020 year-end legislation and could belie concerns that the large…
Medicare GME funding reform debate focuses on rural hospitals
Better-targeted funding is essential to ensure the clinical talent pipeline meets the needs of hospitals in rural and underserved areas, according to insights at a recent congressional hearing. Phelps Health, a rural Missouri hospital, has benefited from federal and state planning and development grants that enabled the launch of a family medicine residency with enhanced…
Gen AI is coming for medical bills: 3 ways to prepare
Patients are behind one of the latest applications of AI to the healthcare revenue cycle, and they are using it to review their bills. Stories of consumers using ChatGPT or other generative AI tools to trim thousands from their medical bills by questioning charges are appearing in the news and social media. YahooFinance wrote about…