Annual Conference 2026, Day 2: With government retrenching, the impetus is on healthcare industry stakeholders to bolster sustainability
Monday video recap: AC26 Day 2 Recap: Big Questions, Bold Conversations In this roundup: With government retrenching, the impetus is on healthcare industry stakeholders to bolster sustainability Insights from the ‘affordability czar’ Jordan reflects on HFMA’s history and what lies ahead Vitalic Health session looks at how technology can drive a better system Most health…
Annual Conference 2026, Day 1: Healthcare AI shows promise, but people come first
Sunday video recap: AC26 Day 1 Recap: Celebrating 80 Years of HFMA Despite AI’s ample potential to improve healthcare, the top investment priority should be people, according to insights at the opening session of HFMA’s 2026 Annual Conference as the Association began its 80th anniversary celebration. The best technologies won’t be optimized unless “we continue…
OBBBA Medicaid cuts increase credit risk for NFP hospitals
Looming healthcare cuts as legislated in the One Big Beautiful Bill Act (OBBBA) constitute the biggest risk to the not-for-profit (NFP) hospital industry, according to insights from experts with the leading credit-rating agencies. The OBBBA is set to hit Medicaid over the next few years, bringing potentially sizable reductions to enrollment along with direct cuts…
340B claims data requirements put hospital discounts under stress
Provider advocates criticized Eli Lilly for ramping up pressure on hospitals to comply with a new policy regarding claims submission in the 340B Drug Pricing Program. The drug manufacturer said holdout hospitals will lose 340B discounts on all Lilly products unless the hospitals quickly comply with a mandate issued earlier this year to submit claims…
Medicaid work requirement rule adds significant wrinkles to program eligibility criteria
For state agencies and potentially healthcare providers, CMS’s regulatory guidance on implementing the Medicaid work requirement imposes responsibilities that go beyond language seen in the underlying statute. CMS published an interim final rule with comment period late Monday, just barely meeting the June 1 deadline established in the 2025 reconciliation law known as the One…
Healthcare affordability and financial sustainability concerns test CFO strategy
Healthcare stakeholders can implement strategies that improve both affordability for consumers and financial sustainability for providers, according to insights from a recent panel discussion. The effort should start with “making sure that we understand what this balance is of financial sustainability of the institution and affordability for the patients, for the consumers, for the communities…
Final rule lowers No Surprises Act IDR fees, adds requirements
Regulations issued Thursday to update the No Surprises Act’s independent dispute resolution (IDR) process represent an effort to improve access while also streamlining the volume of cases. CMS and the Departments of Labor and Treasury published a final rule that significantly lowers IDR fees but includes more requirements of the insurers and providers that seek to use…
340B lawsuits against CVS allege $250M in underpaid hospital reimbursement
CVS Health’s pharmacy benefit manager (PBM) under-reimbursed three health systems by almost $250 million over five years in connection with the 340B Drug Pricing Program, according to new lawsuits. Filed in three separate federal courts, the complaints describe how CVS Health and its subsidiaries retained a large share of the savings generated through the 340B…
Off-campus outpatient billing rules could extend to commercial claims
Hospitals preparing for new off-campus outpatient department (OPD) billing requirements in Medicare may soon face a parallel mandate for commercial claims. The House Education and Workforce Committee on May 21 unanimously passed the Transparency in Billing Act, which would prohibit commercial health plans from paying claims that do not include a unique identifier for the…
CMS’s Medicaid state-directed payment rule would expand limits beyond hospitals
CMS’s proposed rule on Medicaid state-directed payments (SDPs) would implement limits authorized by the One Big Beautiful Bill Act (OBBBA) while applying restrictions to a broader swath of Medicaid, including certain fee-for-service (FFS) supplemental payments. Essentially, the agency issued proposed regulations that would take some of the OBBBA’s Medicaid provisions a step further. Services previously…