2027 Medicare Physician Fee Schedule cuts persist despite CMS concessions
CMS heeded the calls of provider advocates to mitigate proposed reductions to Medicare physician payment for 2027, but the most direct cut remains in place and will require action by Congress to undo. As published Nov. 9, next year’s final rule for the Medicare Physician Fee Schedule includes decreases of 1.83% for physicians meeting criteria…
2027 Medicare OPPS final rule cuts 340B payments, expands site-neutral rates
In the 2027 Medicare final rule for hospital outpatient departments, CMS slightly mitigated several issues that providers had cited regarding the proposed version of the rule. Those steps have not assuaged stakeholder concerns about the rule’s impact on Medicare reimbursement in the hospital outpatient sector. CMS finalizes 2.3% outpatient payment increase and 2% recoupment Hospitals…
2027 Medicare Advantage Star Ratings show gains in high-rated plan enrollment
More than 70% of beneficiaries in Medicare Advantage (MA) plans that include prescription drug coverage are in contracts rated at least four stars out of five, according to CMS’s Star Rating release for 2027. Those plans are in line for quality-bonus payments and in 2028 will receive higher rebates that are used to support supplemental…
Hospital obstetric service closures grow as Congress considers responses
Amid deteriorating access to maternity care across the U.S., Congress is trying to find solutions, while recent data indicate how the situation is playing out at hospitals. A September 2026 report by the University of Minnesota’s Rural Health Research Center states that hospital-based obstetric services declined nationwide between 2010 and 2024, with 718 instances of…
Fast outpatient shift expected from end of IPO list
The ongoing phaseout of Medicare’s inpatient-only list (IPO) likely will move many of those surgical procedures to outpatient settings with lower reimbursement. That expectation is based on site-of-care shifts that happened when CMS previously removed other surgeries from the IPO list, said Allison Oakes, PhD, chief research officer at Trilliant Health. Medicare removed total knee…
2027 Medicare lab fee schedule points to 15% cuts across many test codes
Preliminary data for the 2027 Clinical Laboratory Fee Schedule (CLFS) indicate substantial downward pressure on Medicare reimbursement for lab services. CMS released information on the 2027 payment rates ahead of final rates expected in November, projecting that the methodology used to set the rates would save $1 billion annually for Medicare. Hospital-based and freestanding labs…
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…