Proposed MA rate notice for 2026 looks promising for health plans, which soon could reap more gains
The Biden administration’s final action with respect to Medicare Advantage (MA) provided a boost to health plans, which could fare better yet under the Trump administration. For 2026, MA plans would receive a 2.23% increase in their payment benchmarks, according to an advance rate notice posted Jan. 10. That would represent a reversal from 2024…
How ACOs should prepare for the 2025 requirements around quality reporting
This year, MSSP ACOs face increased pressure to enhance care quality and manage costs with the transition from manual to electronic clinical quality measures (eCQMs) and the MSSP’s intensified compliance requirements. This shift to electronic reporting is a financially driven transformation. The reporting complexity has increased significantly as ACOs are now required to report on…
GOP puts ideas for major healthcare spending cuts in writing
Big healthcare provisions and programs face the prospect of cutbacks as congressional Republicans look to pass a budget for the remainder of FY25. With Donald Trump in place for a second presidential term starting Monday afternoon and narrow Republican majorities in both chambers of Congress, the GOP has a chance to influence federal policy on…
UnitedHealth Group leaders reflect on slain colleague, how the industry can improve
In their first investor call since the targeted killing of their colleague spawned intense debate about aspects of the U.S. healthcare system, UnitedHealth Group leaders said a systemwide focus on improvement is needed. CEO Andrew Witty began this week’s Q4 earnings call by paying tribute to Brian Thompson, UnitedHealthcare’s chief executive, who was fatally shot…
Comparison of Final 2025 OPPS Addendum B with October 2024 Addendum B
HFMA presents a spreadsheet comparing relative weights and payment rates at the HCPCS level.
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…