CY 2025 Physician Fee Schedule Final Rule Summary Part II – MSSP Requirements
HFMA presents part II of three detailed summaries of the final rule relating to the Medicare physician fee schedule for CY 2025 and other revisions to Medicare Part B policies.
CY 2025 Physician Fee Schedule Final Rule Summary – Part I
HFMA presents a summary of the final rule relating to the Medicare physician fee schedule for CY 2025 and other revisions to Medicare Part B policies. The final rule will be published in the December 9, 2024, issue of the "Federal Register."
2 drug manufacturers go to court to turn 340B into a rebate program
Two leading drug manufacturers have pressed forward with efforts to reformat the 340B Drug Pricing Program, filing lawsuits against the federal government over the question of whether savings can be offered as cash rebates rather than up-front discounts. Johnson & Johnson took HHS and the Health Resources and Services Administration (HRSA) to federal court in…
An eventful period for healthcare policy looms as Trump and GOP members of Congress prepare to govern
President-elect Donald Trump and congressional Republicans are expected to implement changes to healthcare policy, including site-neutral payment, price transparency, and modifications to Medicare and Medicaid, while the nomination of Robert F. Kennedy Jr. as HHS Secretary and Mehmet Oz as CMS Administrator could have implications for the healthcare system.
Senate leaders release a blueprint for comprehensive site-neutral payment policies
To the disappointment of hospital groups, two Senate leaders have produced bipartisan policy options for advancing site-neutral payment in Medicare. The framework released Nov. 1 by Sens. Bill Cassidy (R-La.), who is a physician, and Maggie Hassan (D-N.H.) goes further than site-neutral payment plans that were passed by the House as part of broader healthcare…
Providers’ winning streak in No Surprises Act QPA litigation ends as appeals court overturns a prior ruling
Healthcare providers incurred a rare defeat in litigation over a key facet of the No Surprises Act, with an appeals court ruling that the original methodology for calculating the qualifying payment amount (QPA) is permissible. The Oct. 30 decision restores language from prior regulations and means insurers can continue to incorporate or exclude certain disputed…
FY 2025 IPPS/LTCH PPS Interim Final Rule Summary
HFMA presents a detailed summary of the interim final rule with comment published by CMS in the October 3, 2024, Federal Register revising its previously announced FY 2025 policies and rates for Medicare’s IPPS and LTCH PPS.
HFMA provides a comprehensive, curated list of CMS guidance on the 2-midnight rule/benchmark for use by payers and providers
Health systems nationwide continue to report unjust increases in beneficiary cost-sharing and delays in post-acute care by Medicare Advantage (MA) plans. These delays often result from automatic downgrades that contradict CMS requirements, specifically those relating to the agency’s two-midnight rule/benchmark, which mandates adherence by MA plans to establish agency-directed care standards. Despite the mandate that…
Report suggests the extent to which Medicare Advantage health plans are skirting the two-midnight rule
As hospitals struggle with payer tactics involving denials, a new analysis quantifies the extent to which Medicare Advantage (MA) health plans still avoid paying for inpatient care. The report by Kodiak Solutions examined claims data from more than 1,900 hospitals and found that MA plans categorized hospital visits as outpatient observation stays at a rate…
Providers can expect UnitedHealthcare to undertake closer inspection of coding patterns
Healthcare spending that exceeded expectations is motivating UnitedHealthcare to take a more rigorous look at provider coding practices. For two consecutive quarters, parent company UnitedHealth Group (UHG) has reported that the medical-cost ratio (MCR) of UnitedHealthcare is being impacted by several factors. One is provider coding trends, the company’s leaders said during investor calls. “In…