Medicare claims processing modernization gains urgency at CMS
In 2025, the newly created U.S. Department of Government Efficiency (DOGE) was associated with the large-scale culling of staff and a proposed restructuring at HHS, along with substantial reductions in personnel at many other departments. These days, in addition to releasing a massive file of provider-level Medicaid billing data, DOGE is placing its healthcare focus…
DOGE releases (then removes) Medicaid billing data to expand fraud oversight (updated)
The Trump administration’s ongoing push to address fraud in government healthcare programs includes the release of a massive data set showing Medicaid billing patterns of individual providers. With more than 227 million rows of Medicaid fee-for-service and managed-care billing data and roughly 1.8 million national provider identifiers (NPIs), the file shows the NPI for each…
Study details how OBBBA Medicaid cuts will restructure state budgets
A handful of states may gain financially because of the Medicaid provisions legislated in the 2025 reconciliation bill known as the One Big Beautiful Bill Act (OBBBA), according to a new study. Results of an analysis by RAND Health include the finding that state Medicaid budgets will fall by $664 billion between 2025 and 2034,…
GAO examines No Surprises Act payment and network trends
Recent trends seen as a consequence of the No Surprises Act (NSA) include a moderate increase in the share of providers going in-network for some services, according to a report by the Government Accountability Office (GAO). Such a development was a secondary goal of the 2020 year-end legislation and could belie concerns that the large…
Medicare GME funding reform debate focuses on rural hospitals
Better-targeted funding is essential to ensure the clinical talent pipeline meets the needs of hospitals in rural and underserved areas, according to insights at a recent congressional hearing. Phelps Health, a rural Missouri hospital, has benefited from federal and state planning and development grants that enabled the launch of a family medicine residency with enhanced…
HFMA CEO Jordan, healthcare leaders point to urgency of affordability challenges during ViVE conference
There’s an urgency to address healthcare affordability, panelists at a ViVE conference presentation Tuesday, Feb. 24, agreed — and the need for action is driving bold, collaborative ventures among leaders in healthcare, health tech and private equity. “I think the clock’s really ticking for real now,” said Marcus Whitney, founding partner of Jumpstart Health Investors. “I don’t think anyone cares to protect incumbents anymore, so…
Relief might be fleeting for the healthcare industry after Supreme Court strikes down most tariffs
April 3 update The Trump administration announced a 100% tariff on pharmaceuticals, albeit with various exemptions. Unlike the tariffs overturned by the Supreme Court (see the original story below), the pharmaceutical tariffs appear to be on solid legal ground because they resulted from a formal investigation conducted by the U.S. Department of Commerce. Not subject…
Rising healthcare costs strain health system margins
Systemic challenges are showing few signs of easing in healthcare financial operations. As identified by federal actuaries, increases in the use and intensity of hospital services drove a big recent jump in national healthcare spending. Those volume-based metrics represent a boost for hospital revenues but a roadblock to cost reduction. That dichotomy had a net…
Hospitals mount response as site-neutral payment policy progresses
Hospitals and their advocates think the concept of site-neutral payment is gaining enough traction in policy circles that a strategic response is warranted. One step in attempting to stanch the apparent momentum of site-neutral policies is the release of a new report that finds recommended approaches would cut hospital payments by $182 billion over 10…
CMS provides more leeway to Medicaid state-directed payments before new limits kick in
March 23 update The Committee for a Responsible Federal Budget (CRFB), which advocates for deficit reduction, issued an analysis criticizing the extent to which states are capitalizing on the grandfathering clause to maintain higher rates for state-directed payments (SDPs) through 2027. CRFP reported that Illinois and Texas have increased their SDP rates by 50% since…