Annual report on Medicare financing could reduce the immediate impetus to address longstanding issues
New data on the state of Medicare funding show short-term improvement while keeping the stakes high for ensuing decades. The annual report from Medicare’s trustees shows the Hospital Insurance Trust Fund (i.e., Medicare Part A) has enough money to keep beneficiaries covered and providers paid through 2036. That’s an increase of five years from the…
Closures of Walmart’s health centers reflect the widespread financial constraints in U.S. healthcare
Beyond signaling a setback for retail-based healthcare disruptors, Walmart’s recent decision to close its health centers is symptomatic of issues hampering the nation’s ecosystem for primary care, industry analysts say. The retail behemoth announced April 30 it would be closing all 51 of its health centers across five states, along with its virtual-health service. Five…
Congressional hearings on the Change Healthcare cyberattack bring attention to providers’ continuing predicament
Two congressional hearings involving the CEO of UnitedHealth Group offered few concrete solutions to the issues surrounding the Change Healthcare cyberattack but did highlight the ongoing pressures facing healthcare stakeholders. Andrew Witty, the CEO, was questioned May 1 by the Senate Finance Committee in the morning and a House subcommittee in the afternoon. For providers…
Seeking to improve healthcare for Medicaid beneficiaries, CMS issues a flurry of regulations
CMS over the last month published a trio of final rules intended to make the Medicaid program work better for beneficiaries, with implications for healthcare providers. The three rules address eligibility and enrollment, access and Medicaid managed care. Streamlining eligibility and enrollment The first rule addresses administrative barriers in an effort to simplify enrollment processes…
Navigating toward successful contract negotiations with health plans
A group of healthcare leaders discuss various tactics they are using to negotiate better rates with payers and ensure payers’ commitment to accurate, timely payment.
FY 2025 Inpatient Psychiatric Facilities PPS Proposed Rule Summary
HFMA presents a detailed summary of the FY 2025 Inpatient Psychiatric Facilities Prospective Payment System proposed rule, published in the April 3, 2024.
Why the Medicare physician fee schedule is sheer madness
Amid the complexities of U.S. healthcare, there is probably no construct that’s more byzantine than the Medicare Physician Fee Schedule (MPFS) — the program’s elaborate system of paying physicians and other clinicians (including nurse practitioners, physician assistants and clinical psychologists) for more than 10,000 medical services.a In 2022, the schedule drove about $71.2 billion in…
A new 340B dispute resolution process could create more opportunities for providers
Regulatory updates to the administrative dispute resolution (ADR) process in the 340B Drug Pricing Program seem likely to expedite the filing of claims over manufacturers’ refusal to offer discounts on drugs distributed at contract pharmacies. HHS and the Health Resources and Services Administration (HRSA), which administers the 340B program, published a final rule that modifies…
FY 2025 Inpatient Rehabilitation Facility PPS Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule published by CMS on the Medicare inpatient rehabilitation facility prospective payment system updates for FY 2025.
FY 2025 IPPS/LTCH PPS Proposed Rule Summary
HFMA presents a detailed summary of the FY 2025 IPPS/LTCH prospective payment system proposed rule, released by CMS on April 10, 2024.