Elevance Health rebuffs providers’ calls to cancel a contentious out-of-network payment policy
Healthcare providers in 11 states face the imminent possibility of payment reductions from a top subsidiary of Elevance Health, one of the nation’s largest insurers. Anthem Blue Cross and Blue Shield announced this quarter that it would apply a 10% penalty to the allowed amount on commercial insurance claims when hospital care is provided by…
CMS plans to bar hospitals from Medicare and Medicaid participation for providing gender-affirming care to minors
Hospitals would face significant financial consequences for providing gender-affirming care as treatment for minors who have gender dysphoria, according to a newly proposed rule from CMS. Specifically, any hospital offering care such as puberty blockers, hormone therapy and surgery to minors would be locked out of Medicare and Medicaid, the agency said in announcing formal…
OBBBA Medicaid impacts: How to navigate state-directed payment revenue reduction
On July 4, 2025, President Trump signed the One Big Beautiful Bill Act (OBBBA) into law, initiating one of the most significant shifts in federal fiscal policy in recent years. The legislation introduces sweeping tax reforms and spending reductions, with healthcare providers positioned to experience the most substantial impact. OBBBA authorizes a $1 trillion reduction in federal Medicaid spending…
Texas hospitals fall short in an appellate ruling about disproportionate share hospital payment calculations
An appeals court dealt hospitals a defeat in a case about Medicare disproportionate share hospital (DSH) payments, reversing a lower court’s prior ruling on jurisdictional grounds last week. A Dec. 9 decision by a three-judge panel at the U.S. Court of Appeals for the Fifth Circuit means certain Section 1115 waiver days can remain excluded…
MedPAC finds the hospital industry is on a more stable financial footing now
Hospitals do not need a Medicare payment boost for 2027 beyond the update to be provided in the statutory formula, says the Medicare Payment Advisory Commission (MedPAC). Whereas the commission had recommended that Congress increase hospital payments by an additional 1% or 1.5% ahead of each year from 2024 through 2026, the recommendation for 2027…
2026 Physician Fee Schedule Specialty Impact Tables
HFMA presents a specialty impact analyses contained in one spreadsheet based on the 2026 Medicare physician fee schedule final rule.
Comparison of CY 2026 Physician Fee Schedule Payment Rates to the 2025 Payment Rates
HFMA presents a spreadsheet comparing 2026 physician fee schedule payment rates to 2025 payment rates.
MedPAC December 2025 Public Meeting Summary
HFMA presents a detailed summary of the MedPAC public meeting held on the December 4-5, 2025.
Questions loom over the future of telehealth policy
Federal telehealth policy continues to prove confounding for healthcare providers. The recent 43-day government shutdown marked the first extended period since the early days of the COVID-19 pandemic that traditional restrictions on telehealth reimbursement were in place. Medicare waivers of those restrictions helped telehealth utilization surge during the pandemic and remain elevated in the years…
Contract Year 2027 Revisions to Medicare Advantage and Medicare Prescription Drug Benefit Programs Proposed Rule Summary
HFMA presents a detailed summary of a proposed rule that would revise the Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), and Medicare cost plan regulations for Contract Year 2027. Comments on the proposed rule are due by January 26, 2026.