Finalized regulations look to phase out the manual aspect of prior authorization
Medicare’s FY26 final rule for hospital inpatient payments includes the latest federal effort to streamline and improve prior authorization. The rule has a subset of regulations titled “Health Data, Technology and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit and Electronic Prior Authorization,” issued by HHS’s Assistant Secretary for Technology Policy and Office of the National Coordinator…
340B rebate models arrive in the form of a new pilot program
Federal healthcare officials took a step last week toward permitting rebate models in the 340B Drug Pricing Program, launching a pilot to allow for the testing of such models. The idea was proposed over the past year by drug manufacturers looking to rein in what they say are excesses of the 340B program. Rather than…
News Briefs: Budget reconciliation bill finalized with big implications for Medicaid
Declines in coverage and spending await the healthcare industry under the budget reconciliation bill signed into law by President Donald Trump on July 4. The Congressional Budget Office (CBO) projects $912 billion in reduced Medicaid spending and 10 million additional uninsured Americans in 2034 as a result of the law known as the One Big…
Medicare final rule brings a mixed bag for FY26 hospital inpatient payments
Hospitals collectively will receive a base payment increase of 2.6% in Medicare reimbursement for inpatient care provided in FY26, according to a newly published final rule. It’s a somewhat uneventful set of regulations compared with the recently released 2026 proposed rule for Medicare outpatient payments. But hospitals were hoping for a bigger inpatient update, with…
CMS looks to modernize the U.S. digital health infrastructure
Eight health systems have joined a Trump administration initiative to accelerate the implementation of integrated patient-facing technology in the healthcare ecosystem. The agreement is a voluntary pledge by the health systems to be early adopters of forthcoming technology that will be designed, in part, to enhance interoperability and eliminate paper-based clinical encounters. Participants will be…
Soaring charity care grabs hospital leaders’ attention
Across the country, hospitals are reexamining their approach to uncompensated care, with first movers in this space increasing the availability of financial assistance and working harder to reduce the chances that an account will be sent to collections. And now, new data paints a picture of the collective impact of these efforts and other trends…
Reeling payers plan to increase scrutiny of providers’ coding practices
Health insurers see provider coding practices as one factor in unfavorable cost trends, several companies said during recent earnings calls. Those cost trends, in turn, have driven substandard Q2 financial results. “We know this adjustment is disappointing, and we’re taking concrete actions to address it,” Gail Boudreaux, president and CEO of Elevance Health said recently,…
In comments, for-profit hospital leaders don’t dwell on ‘Big Beautiful Bill’ impact
Leaders of for-profit hospital chains ranged from noncommittal to confident in recent remarks about impending rollbacks to Medicaid and the Affordable Care Act (ACA). Hospitals have several years to prepare for some of the changes, and the interval also leaves time to modify policies in the newly passed budget reconciliation bill, health system leaders said…
Get paid what you’re owed: Smarter contracting, internal alignment can reduce denials
Hospitals and health systems are grappling with rising denial rates, particularly among commercial and Medicare Advantage plans. Years ago, denials might have been isolated friction points in the billing process; but as rates have risen, denials have become a strategic-level issue with a measurable impact on financial performance. Historically, denial mitigation efforts tended to focus on…
AI technology brings wholesale CDI benefits to Intermountain Health
At a time when the healthcare labor picture is marked by sustained high costs and shortages of key roles, one department at Intermountain Health found a way to operate as though it had six additional FTEs without an increase in the headcount. The enhanced productivity was one benefit of implementing AI technology in clinical documentation…