States and hospitals prepare for new administrative tasks as Medicaid work requirements loom
Efforts by states to implement the Medicaid work requirement are intensifying, with hospitals likely to play a supporting administrative role when the requirement begins nationwide Jan. 1, 2027, based on findings in a new report. As legislated in the One Big Beautiful Bill Act (OBBBA), adults in the Medicaid expansion population must demonstrate that they…
PAMA laboratory data reporting requirements for hospitals are set to impact Medicare lab payments
Hospitals offering clinical diagnostic laboratory services should take note of imminent reporting obligations that will affect Medicare payment rates. Reporting of commercial final-paid claim rates as the basis for Medicare rate setting was included in the Protecting Access to Medicare Act of 2014 (PAMA) and initially took place in 2017. Subsequent phases of data reporting…
Site-neutral payment debate intensifies in hospital affordability hearing
Site-neutral payment is at the forefront of the debate on policy levers to enhance affordability in the hospital industry, as indicated during a congressional hearing Tuesday. The House Ways and Means Committee hosted a panel of hospital CEOs, seeking insights on ways to tamp down spending on hospital care. Prices in the sector have risen…
ACA marketplace constraints reduce hospital revenue, shift payer mix
Coverage changes in government healthcare programs are starting to show up in hospital financials, based on Q1 reporting from the for-profit hospital sector. Most notably, 2026 cutbacks in Affordable Care Act (ACA) marketplace coverage are manifesting in lower revenues, while hospitals are getting a taste of what’s to come next year in Medicaid coverage. In…
CMS proposes electronic prior authorization for drugs
May 11 update Developments since publication of this article include CMS’s announcement that implementation of electronic prior authorization would be added to the pledges taken by participants in the Health Tech Ecosystem. The ecosystem is a public-private partnership launched in 2025 to establish a nationwide digital healthcare infrastructure that improves data interoperability and empowers patients…
Hospital margins decline in 2026 as expenses outpace revenue
As hospitals seek to shore up their finances in a challenging environment, cost-focused initiatives are taking priority. “Organizations are saying, ‘We’ve got the revenue picture, [now] we’ve really got to get our expense picture to be sustainable with our revenue picture,’” said Steve Wasson, chief data and intelligence officer with Strata Decision Technology. “And what…
The Revenue Cycle of the Future: AI boom and workflow redesigns accelerate rev cycle transformation
Hospitals of all sizes are leveraging AI advancements and workflow redesigns to modernize revenue cycle management, aiming to lower costs, improve operational efficiency, and enhance the patient experience. While technology such as predictive analytics and automation shows promise in streamlining tasks, challenges remain in workforce adaptation, skill shifts, and the need for strategic collaboration, as leaders work to balance innovation with employee training and retention in an increasingly tech-driven environment.
Out-of-network pricing lawsuits test MultiPlan, Zelis business models
April 27 update Zelis provided a statement to HFMA regarding the lawsuit against the company’s out-of-network pricing model (see the original story below). “Last month’s decision was procedural and does not change Zelis’s position,” a company spokesperson said. “Zelis operates with a strong commitment to integrity, transparency and full compliance with all applicable laws and…
Medicare payment policy changes for 2027: Key signals from Kennedy hearings
Amid ample rancor, some of the rhetoric during congressional appearances Thursday by HHS Secretary Robert F. Kennedy Jr. had substantive implications for healthcare industry stakeholders. During two House hearings to discuss his department’s proposed FY27 budget, Kennedy and members of the Ways and Means Committee and a subpanel of the Appropriations Committee touched on a…
H-1B visa fee strains the healthcare workforce and hospital finances
In the year after implementation of a new White House policy curtailing the pipeline for legal immigration, the healthcare industry is grappling with the implications. In September, the Trump administration announced that the H-1B visa program for skilled workers seeking to enter the U.S. would carry a $100,000 fee per application. Healthcare, along with higher…