2025 Final OPPS APC/HCPCS Lookup Tool
HFMA presents a spreadsheet allowing users to pull-up basic descriptive and payment information for CY 2025 OPPS APC/HCPS codes.
In surprise move, Biden administration terminates the Medicare Advantage Value-Based Insurance Design Model
A nearly decade-long effort to promote value-based insurance design (VBID) in Medicare Advantage (MA) will be discontinued after 2025, the Biden administration announced in December. The MA VBID Model has aimed to use health plan benefits design to encourage healthy behaviors and promote whole-person health among segments of beneficiaries. It began in 2017 and, after…
Amid tight margins, MedPAC seems set to recommend an additional hospital payment boost
Hospitals have improved financially in the latest reporting period but still should receive a supplementary Medicare payment increase, according to a meeting of the Medicare Payment Advisory Commission (MedPAC). For 2026, Congress should authorize a 1% increase beyond the amount calculated using the statutory methodology, commissioners said during a December discussion. The notion is likely…
Which healthcare policies were kept in a doomed second version of the continuing resolution?
A slimmed-down version of a year-end government funding package retained some of the core healthcare provisions from a larger previous version, but little was certain after the second version failed to pass the House of Representatives. After President-elect Donald Trump spoke out against a bipartisan agreement Wednesday night, Republicans in the House drafted a streamlined…
Year-end spending legislation looks promising for healthcare stakeholders — if it passes
Advocates for hospitals and other healthcare providers generally commended an end-of-the-year federal spending package that includes most of their requested provisions. However, a specific item loomed as a source of concern in the hospital sector, and by early Wednesday evening, there were questions about the viability of the entire bill. Congress released text for a…
CY 2025 OPPS/ASC Final Rule Summary
HFMA presents a detailed summary of the calendar year 2025 final rule for the Medicare hospital outpatient prospective payment system and ambulatory surgical center payment system.
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…
CY 2025 End-Stage Renal Disease PPS Final Rule Summary
HFMA presents a detailed summary of the final rule updating the end-stage renal disease prospective payment system for CY 2025.
2 proposed rules seek to stem insurers’ use of prior authorization, medical management
In its waning days, the Biden administration hopes to lay additional groundwork for curbing health plan policies regarding prior authorization in Medicare Advantage (MA), along with group health plan tactics that may interfere with access to certain preventive items and services. MA prior authorization criteria A proposed rule implementing 2026 policy and technical changes for…
A nearly $3 billion settlement with Blue Cross Blue Shield leaves providers with a big choice (updated)
Note: The second section of this article was updated Dec. 5 with news that the proposed settlement has been formally approved. Providers that contract with Blue Cross Blue Shield should assess whether they want to participate in a landmark class-action settlement over litigation stemming from complaints about the insurer’s business practices. In October, a resolution…