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…
MedPAC sees no broad Medicare Advantage hit to hospital finances
Recent growth in Medicare Advantage (MA) enrollment is not associated with an adverse impact on the finances of hospitals and post-acute care providers, based on findings of an observational study by the Medicare Payment Advisory Commission (MedPAC). However, the shift of beneficiaries from traditional Medicare to MA is affecting providers operationally and could be skewing…
News Briefs: CMS proposes a modest increase to hospital inpatient payments for FY27
CMS projects an average Medicare inpatient payment increase of 2.4%, totaling $1.4 billion industrywide, when the new fiscal year begins Oct. 1. The update, described in a proposed rule for inpatient care and long-term care hospitals (LTCHs), is based on a 3.2% increase to the market basket and a 0.8% reduction via a mandatory economywide productivity adjustment.…
Oct. 6, 2025: The healthcare impacts of a federal government shutdown
HFMA Senior Editor Nick Hut and HFMA Policy Director Shawn Stack discuss the latest in healthcare finance news.
News Briefs: Medicare offers a restrained inpatient payment update for FY26
Hospitals collectively will receive a base payment increase of 2.6% in Medicare reimbursement for inpatient care provided in FY26, according to a final rule published Aug. 6 in the Federal Register. Advocates were seeking a bigger update. With rising costs and reimbursement constraints projected in upcoming years, especially after passage of the budget reconciliation bill known as the…
Understanding the signals amid the noise: What’s really happening with Medicare Advantage?
In healthcare circles, the buzz continues: Providers are exiting Medicare Advantage (MA) arrangements in large numbers. An HFMA survey found that 19% of provider organizations stopped accepting one or more MA plans in 2023 with almost 60% of respondents either planning or considering a pause on one or more MA plans in the next 24…
New CMS bundled payment initiative may be the future of Medicare
CMS's Transforming Episode Accountability Model (TEAM) is a new bundled payment model that aims to move Medicare beneficiaries into value-based care arrangements by 2030, and hospitals participating in the model will be financially responsible for the cost and quality of care for five procedures.