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…
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…
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…
Perils and promise of Medicare Advantage highlighted at congressional hearing
Testimony during a congressional hearing this week highlighted the strain hospitals are experiencing from the administrative roadblocks posed by Medicare Advantage (MA). For all the potential seen in the program to improve health and care delivery, MA is not working the way it should, several industry experts acknowledged during the July 22 joint hearing of…
The latest on providers’ landmark antitrust suit alleging price fixing by MultiPlan and healthcare insurers
Billions of dollars are at issue in an ongoing lawsuit in which providers allege price fixing by a vendor and a large segment of the health insurance industry. Providers bringing the suit maintain that the healthcare technology solutions company MultiPlan and roughly 700 health plans conspired to suppress reimbursement for out-of-network services over a decade…
In Medicare’s latest hospital-focused rule, CMS pushes new proposals for price and quality transparency
Medicare’s 2026 proposed rule for hospital outpatient care includes the Trump administration’s latest effort to augment price transparency requirements. Two months after updated guidance featured a mandate to immediately start posting actual prices rather than estimates in machine-readable files (MRFs), among other directives, the proposed rule contains further steps in the name of specificity. The…
Proposed Medicare hospital payment rule includes a surprising cut
Although payment rates technically would increase under Medicare’s 2026 proposed rule for hospital outpatient care, various provisions would chip away at the finances of hospitals and health systems. Specifically, key provisions would equalize certain site-based payments and also accelerate a planned across-the-board payment decrease related to 2022 remedy payments that were made to 340B Drug…