Federal shutdown delays Medicaid payment approvals, health leaders say
The federal government shutdown has halted the approval of new Medicaid state-directed payments (SDPs), with some states still under consideration, and the financial impact on health systems will vary depending on the outcome.
Employers underestimate employees’ healthcare affordability struggles, survey finds
New survey data shows that 44% of employees with employer-sponsored insurance struggle to afford out-of-pocket healthcare costs, while employers overestimate their employees' ability to meet these costs.
Administrative costs outpace direct patient care at US hospitals
Hospital administrative costs have increased significantly in recent years, with administrative spending now 199% of direct patient care costs, driven by increased government reporting requirements and other wasteful activities, according to a recent analysis.
Staffing issues fuel healthcare unionization efforts nationwide
Healthcare unionization is increasing due to a lack of employee satisfaction post-pandemic, with staffing issues and a shift in workforce expectations being major drivers of discontent.
Hospital advocates urge CMS to scrap new prior authorization model
Hospital advocates have urged CMS to scrap the new AI-driven prior authorization model, which they believe could lead to increased denials of legitimate claims and an increased administrative burden for rural facilities.
Employers find success in healthcare savings through TPA shift and payment integrity
The Health Transformation Alliance (HTA) has identified three approaches that have saved its member companies the most in healthcare expenditures, including switching to TPAs, shifting to a full pass-through pharmacy benefit manager, and pushing payment integrity.
Congress pressures CMS to implement No Surprises Act requirements
CMS is expected to implement long-delayed transparency rules for payers and providers, including Good Faith Estimates and Advanced Explanation of Benefits, in 2026, after years of pressure from Congress and industry stakeholders.
Hospitals brace for leaner contracts as Medicare Advantage plans face financial pressures
Medicare Advantage plans are projecting a 900,000 drop in enrollment in 2026, which could have negative consequences for hospitals and health systems due to plans under increased financial pressure pushing administrative requirements.
AI adoption in healthcare finance lags despite claims process promise
Despite two-thirds of healthcare finance professionals seeing the promise of AI to improve the claims process, only 14% have implemented it on claims denials, due to concerns about accuracy, HIPAA compliance, and complexity of training teams.
FastFinance: How employers are cutting healthcare costs
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. An employer group identifies the most effective cost-cutting approaches large businesses have found for their employee healthcare coverage. Also, this week’s Weird Number: $1.7 billion is available for hospitals from the…