Comparison of Final 2025 OPPS Addendum A with October 2024 Addendum A
HFMA presents a spreadsheet comparing relative weights and payment rates at the APC level, using the most recent 2025 and 2024 Addendum A spreadsheets.
Medicare financial support for low-wage hospitals hits another roadblock in the courts
Plaintiff hospitals won a second consecutive appeals-court victory in the legal fight over Medicare’s low-wage-index policy. In December, the U.S. Court of Appeals for the Ninth Circuit upheld a district court’s ruling that the policy of increasing wage-index values for rural hospitals starting in 2020 was impermissible under the Medicare statute. The decision echoed a…
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.