How to respond to Medicare Advantage’s rising headwinds
In recent years, the Medicare Advantage (MA) program has enjoyed rapid membership growth. About 33 million Americans — or 54% of all Medicare-eligible individuals — are currently enrolled in MA, according to a recent Kaiser Family Foundation analysis.a For providers and payers that participate in MA, success is predicated on facilitating a virtuous cycle: a…
Medicare administrative contractor news includes a data breach and potential consolidation
Recent happenings involving Medicare administrative contractors (MACs) include a notice of a data breach and a request for feedback on possible consolidation. CMS sent out word that nearly 950,000 Medicare beneficiaries whose claims go through Wisconsin Physicians Service Insurance Corporation (WPS) are being informed that their protected health information or other personally identifiable information may…
Congress only has a few more months to ensure expansive telehealth access continues (updated)
Note: This article was updated Sept. 18 and Sept. 19 with information about new telehealth legislation. See the updates below. The clock is ticking on efforts to maintain the telehealth flexibilities that have been in place since the start of the COVID-19 pandemic, with advocates hoping Congress will act before year’s end. Key waivers will…
CY 2025 Physician Fee Schedule Proposed Rule Summary – Part I
HFMA presents Part I of three detailed summaries of the proposed rule relating to the Medicare physician fee schedule for CY 2025 and other revisions to Medicare Part B policies.
Mandatory Medicare bundled payments and respiratory disease reporting are on the way for hospitals
Hospitals in nearly a quarter of U.S. markets soon will be required to participate in a Medicare bundled payment model covering five surgical procedures, CMS said in newly released regulations. The model is among several policies of note in Medicare’s FY25 final rule for hospital inpatient care and long-term care hospitals. See this previous article…
CY 2025 Home Health Prospective Payment System Proposed Rule Summary
HFMA presents a detailed summary of the CY 2025 proposed rule updating payment rates for home health agencies.
Hospitals will get only a small bump in Medicare inpatient payments for FY25
Hospital representatives were less than excited about the rate update in Medicare’s FY25 final rule for inpatient care and long-term care hospitals. Published Aug. 1, the rule includes a 2.9% rate increase for acute care hospitals in the fiscal year that begins Oct. 1. The increase is derived from a 3.4% hike in the market…
Grace-Marie Turner: Medical innovation should not be stymied by misguided policy
The Inflation Reduction Act and the proposed march-in rights framework are threatening medical progress and innovation, leading to higher costs for seniors, fewer job opportunities, and a decrease in the number of new drugs brought to market.
Appeals court eliminates Medicare supplemental payments for low-wage hospitals (updated-2)
Note: This article was updated most recently Oct. 4 with news that CMS has ended the low-wage-index policy. See that update below. Plaintiff hospitals won litigation last week at the federal appellate level that will adversely affect Medicare payment for some rural hospitals. The U.S. Court of Appeals for the D.C. Circuit backed a district…
As providers seek resolution of continuing Change Healthcare issues, UnitedHealth Group reports strong financials
The aftermath of the Change Healthcare cyberattack affected the second-quarter financials of parent company UnitedHealth Group (UHG), but not to the point of hindering the company’s continued “diversified and durable growth,” CEO Andrew Witty said during a recent investor call. Q2 revenues increased by 6% year-over-year, while profits dropped by 5.5% amid costs stemming from…