Legal and Regulatory Compliance

Medicare’s proposed 2025 rule for physician payments would add to the financial strain facing practices

Medicare’s proposed update to physician payments for 2025 left advocates saying practices will have an increasingly difficult time making ends meet. CMS’s newly proposed rule states that payments are set to be reduced by 2.8% from 2024, based on the change to the conversion factor. The agency explained that it is obligated to implement the…

Nick Hut July 18, 2024

A proposed Medicare condition of participation would bring a slew of new requirements for OB care

Note: HFMA’s coverage of the payment update in the outpatient payment proposed rule can be found here. Hospitals intending to participate in Medicare must meet new standards for obstetric (OB) care, according to CMS’s proposed outpatient rule for 2025. The rule proposes to establish a new Medicare condition of participation (CoP), whereby hospitals and critical…

Nick Hut July 12, 2024

Healthcare providers face Medicare payment-rate penalties for information blocking under new rule

Healthcare providers will receive a lower Medicare payment update if they are deemed to have engaged in information blocking, according to a final rule from HHS and CMS. For hospitals, a violation will leave the organization noncompliant with the Promoting Interoperability Program, meaning it would lose out on three-quarters of the annual market-basket update for…

Nick Hut July 3, 2024

Supreme Court ruling on Chevron makes regulations in healthcare (and other industries) more vulnerable to legal challenges

The U.S. Supreme Court issued a decision Friday that has dramatic implications for the regulatory infrastructure in healthcare, among many other industries. Since it was established in a 1984 case, Chevron deference has served as guidance to courts that regulatory authorities such as CMS and dozens of others across the federal government have license to…

Nick Hut June 28, 2024

Preventive-services coverage mandate for Affordable Care Act plans remains intact following appeals court ruling

In a decision that could have been consequential for health insurance coverage offered through the Affordable Care Act (ACA) marketplaces, an appeals court limited the immediate impact. The U.S. Court of Appeals for the Fifth Circuit upheld a lower-court ruling that preventive-care mandates for ACA health plans are unconstitutional. But the appeals court said the…

Nick Hut June 24, 2024

Hospitals can bring their case on disproportionate share hospital payments to the Supreme Court

The Supreme Court granted hospitals’ request that it hear their appeal about the formula for determining Medicare disproportionate share hospital (DSH) payments, landing the case on the docket for the 2024-25 term. More than 200 hospitals are plaintiffs in the case. A federal district court ruled for HHS and against the hospitals in 2022, and…

Nick Hut June 12, 2024

340B providers are at a disadvantage after the latest court ruling on contract pharmacies

A decision issued by an appeals court represents the latest setback for 340B providers hoping to secure widespread access to price discounts on Medicare Part B drugs. The U.S. Court of Appeals for the District of Columbia Circuit on May 21 upheld a district-court ruling that drug manufacturers can impose restrictions on the 340B discounts…

Nick Hut May 24, 2024

Healthcare Blame Game: What media and lawmakers don’t understand about hospital finances

In this episode, HFMA policy director Andrew Donahue discusses margins, investments and M&A and what measure tells the real story of hospital finance.

Erika Grotto May 23, 2024

Optimizing 340B participation compliantly while “waiting and watching” new developments

Since 1992, the 340B program has required drug manufacturers to provide eligible healthcare organizations and other covered entities with drugs to be used for these organizations’ outpatients at significantly reduced prices, with the intent of helping safety net organizations improve their financial stability. In turn, hospitals are expected to demonstrate that the savings they receive…

Lauren Gorski May 22, 2024

HHS issues regulations to strengthen anti-discriminatory protections in healthcare (updated)

July 3 update A judge with the Southern District of Mississippi federal court granted an injunction preventing the Biden administration from enforcing regulations expanding anti-discrimination protections in the Affordable Care Act (ACA). Issued two days before the new rule was to take effect, the order applies to the provisions concerning gender identity. The move came…

Nick Hut May 14, 2024
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