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…
Relief might be fleeting for the healthcare industry after Supreme Court strikes down most tariffs
The Supreme Court decision striking down most of the Trump administration’s tariff policy negated many of the tariffs that have affected healthcare and other industries since beginning in August 2025. The high court issued a 6-3 ruling Friday that found tariffs initiated under the International Emergency Economic Powers Act (IEEPA) are invalid because the statute…
Rising healthcare costs strain health system margins
Systemic challenges are showing few signs of easing in healthcare financial operations. As identified by federal actuaries, increases in the use and intensity of hospital services drove a big recent jump in national healthcare spending. Those volume-based metrics represent a boost for hospital revenues but a roadblock to cost reduction. That dichotomy had a net…
Hospitals mount response as site-neutral payment policy progresses
Hospitals and their advocates think the concept of site-neutral payment is gaining enough traction in policy circles that a strategic response is warranted. One step in attempting to stanch the apparent momentum of site-neutral policies is the release of a new report that finds recommended approaches would cut hospital payments by $182 billion over 10…
CMS provides more leeway to Medicaid state-directed payments before new limits kick in
CMS issued guidance that expands the opportunity for providers to receive a key Medicaid supplemental payment at a higher rate over the next two years. The bulletin regarding Medicaid state-directed payments (SDPs) makes it easier for states to maintain eligibility for higher SDPs before the legislation known as the One Big Beautiful Bill Act (OBBBA)…
Transparency in Coverage proposed rule aims to make price files more usable
HHS’s proposed updates to health plan price transparency files mark a notable step in ensuring the information is useful for providers and other healthcare stakeholders, experts say. The Transparency in Coverage (TiC) proposed rule issued in December would modify requirements for health plans with an eye toward making the massive machine-readable files (MRFs) more navigable…