Projected Medicare Advantage 2027 payment rate draws concern from plans and providers
CMS’s proposed Medicare Advantage (MA) 2027 payment rate would result in minimal overall growth for health plans, with average payments to MA plans projected to increase by only 0.09%, according to the MA advance rate notice published this week. MA policy increasingly has grabbed headlines in conjunction with the program’s enrollment surge from 33% of…
How a looming federal mandate will affect hospitals
Nick and Shawn discuss appropriations efforts and how various provisions will affect hospitals, specifically in outpatient department claims. Note: After the recording of this episode, the parties hit a roadblock on the bill that was the main topic of discussion. Check out our news coverage for the latest.
Health insurers tell Congress their operations aren’t the cause of high healthcare costs
The debate over the root causes of surging healthcare costs came to Capitol Hill this week as health insurance executives defended their business models to Congress. While acknowledging bipartisan criticism after a year when the cost of employer-sponsored family coverage grew by 6%, with similar or larger projections for 2026, the executives said the crux…
Site-neutral payment emerges as Medicaid savings tool in GOP reconciliation plan
Congressional Republicans are touting healthcare competition and consumer choice, along with expanded site-neutral payment, in a preliminary framework for a second reconciliation bill. The Republican Study Committee in the U.S. House of Representatives put forth ideas geared toward healthcare policies, home prices, energy prices, credits for stay-at-home parents and more, along with proposals to cut…
Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model Summary
HFMA presents a detailed summary of CMMI’s Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model.
Trump releases healthcare plan that would have major implications for the industry
President Donald Trump’s newly released healthcare plan would promote transparency and consumerism and usher in significant changes to coverage, with some stakeholders saying more information is necessary to make a valid assessment of the pros and cons. Touted as a push to address wider issues with affordability, the plan requires Congress to fill in the…
No Surprises Act IDR enforcement uncertain after Supreme Court declines review
Inaction by the Supreme Court this week raised new questions about enforcement of the No Surprises Act’s independent dispute resolution (IDR) process. The high court denied a petition by two air ambulance companies to review a circuit court’s 2025 decision that IDR awards are not enforceable in federal court. That opinion by the U.S. Court…
Hospital-insurer contract disputes could intensify as cost pressures persist
Relationships between hospitals and health insurers are expected to undergo further strain this year, according to analysts with a leading credit ratings agency. “Providers are still dealing with rising operating costs, labor supplies and infrastructure that outpace what insurers have been willing to pay in recent years,” said Bradley Ellis, senior director for the U.S.…
Affordable Care Act subsidy extension progresses, but many questions persist (updated Jan. 13)
Note: A section of this article has been updated with the latest ACA enrollment numbers for 2026 Momentum in Congress is building toward an extension of the enhanced subsidies for buying Affordable Care Act (ACA) marketplace coverage, although successful passage would not negate the ongoing uncertainty. On Jan. 8, the House of Representatives passed a…
DMEPOS Fee Schedule Rate Comparison Tables for 2025 and 2026
HFMA presents a spreadsheet comparing calendar year 2026 to 2025 payment rates for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule.