MedPAC examines Medicare spending shifts and hospital payment pressures
Depletion looms in as few as seven years for Medicare’s Hospital Insurance Trust Fund even amid long-term drops in Part A spending per beneficiary, according to insights from a meeting of the Medicare Payment Advisory Commission (MedPAC). The Congressional Budget Office (CBO) has put the depletion date at 14 years out, or seven years later…
Federal court vacates Medicare DSH rule affecting 2005-2013 payments
In a decision with implications for a larger case, a federal court on Aug. 28 vacated a 2023 rule that affected the calculation of Medicare disproportionate share hospital (DSH) payments retroactively over a nine-year period. As stated in a September 2025 ruling on the merits, the court found the rule to be unlawfully retroactive, as…
CMS proposes faster Medicare coverage for breakthrough medical devices
Medicare coverage of some breakthrough medical devices would be accelerated under a Trump administration proposal released this month. CMS published an Aug. 11 notice of proposed processes that would include issuing an initial national coverage determination (NCD) simultaneously with FDA authorization of an eligible device and finalizing Medicare coverage within three months of authorization. As…
CMS proposes new 340B reporting and HOPD attestation requirements
Recently published editions of two annual Medicare proposed rules both included provisions creating new administrative tasks for hospitals. CMS’s proposed rule for hospital outpatient care would formalize a system of required attestation for off-campus hospital sites starting in 2028, while the rule for physician payments would establish obligatory submission of 340B-related data to a centralized…
Medicare DSH payments ruling could boost hospital reimbursement under 1115 waivers
Hospitals obtained a victory in a case about Medicare disproportionate share hospital (DSH) payments, with potentially significant reimbursement implications. In a July 27 ruling in Covenant Medical Center v. Kennedy, a judge with the U.S. District Court for Northern Texas struck down an HHS rule that excluded certain patients from the DSH formula if they were…
CJR-X mandatory bundled payment model begins for hospitals in 2028
Hospitals have 17 months to prepare for the first mandatory nationwide alternative payment model, as established in Medicare’s FY27 final rule for the Inpatient Prospective Payment System (IPPS) and long-term care hospitals (LTCHs). The final rule makes no major changes to the proposal issued earlier this year for the CJR-X Model, which will require most…
2027 Medicare Physician Fee Schedule proposed rule includes broad payment changes
Physicians will incur a payment decrease in 2027 unless Congress intervenes, according to a CMS proposed rule issued July 14 for the Medicare Physician Fee Schedule. Statutory provisions call for increases of 0.75% for clinicians participating in advanced alternative payment models (APMs) and 0.25% for nonparticipants. However, those raises and a 0.53% bump stemming from…
Medicare skin substitute reimbursement changes have raised provider risks
A formerly high-revenue healthcare service has been diminished on several fronts in 2026. Medicare Part B spending on skin substitutes increased by 640% between 2022 and 2024, reaching nearly $3 billion per quarter, according to a government report. Steps taken by CMS and policymakers to counter that trend include an overhauled payment system and an…
FastFinance: AI nurse opposition; OPPS changes detailed
HFMA’s FastFinance newsletter is now a podcast. Host Rich Daly discusses the most current and relevant healthcare news, delivered in an easily digestible format. AI resistance by nurses is spreading nationwide but there are ways hospitals can use it to boost their productivity while minimizing opposition. Also, this week’s Weird Number: 66%. That’s the share…
CMS’s 2027 OPPS proposed rule would cut 340B and imaging payments
Medicare payment for 340B drugs and imaging services would incur notable reductions under CMS’s 2027 proposed rule for the hospital Outpatient Prospective Payment System (OPPS) and ambulatory surgical centers (ASCs). Payment for many services would increase due to budget neutrality requirements, but the net impact of the various changes projects to be negative for most…