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.
CMMI payment models signal broader Medicare reimbursement shifts
CMS’s Center for Medicare & Medicaid Innovation (CMMI) was busy during the last two months of 2025, announcing a number of new models designed to improve healthcare and keep costs in check. Some address specific priorities of President Donald Trump or HHS Secretary Robert F. Kennedy Jr. New models scheduled for implementation over the next…
340B rebate model no longer beginning Jan. 1 after court issues preliminary injunction (updated Jan. 12)
Note: The last section of this article was updated with news that HHS is stepping back from its appeal of the litigation. A federal court stopped implementation of a 340B Drug Pricing Program rebate model that had drawn fierce opposition from providers. The Dec. 29 preliminary injunction by a Trump-appointed judge at the U.S. District…
Voices in Healthcare Finance: Looking ahead to 2026
Nick Hut and Shawn Stack discuss what’s coming in healthcare in 2026 with Katie Gilfillan from HFMA’s policy team.
What to expect from an inpatient-outpatient site-neutral payment system for Medicare
A recent final rule for the Medicare outpatient prospective payment system (OPPS) gradually eliminates over a three-year period the requirement that some procedures can only be performed in an inpatient site of service.a In the rule, CMS eliminates what is colloquially known as the “inpatient-only list” to make more procedures eligible to be performed in…
Alternative Payment Model Updates and the Increasing Organ Transplant Access Model Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule that would update and revise the Increasing Organ Transplant Access (IOTA) Model.
MACPAC December 2025 Public Meeting Summary
HFMA presents a detailed summary of the Medicaid and CHIP Payment and Access Commission’s (MACPAC’s) public meeting held on December 11, 2025.
Elevance Health rebuffs providers’ calls to cancel a contentious out-of-network payment policy
Healthcare providers in 11 states face the imminent possibility of payment reductions from a top subsidiary of Elevance Health, one of the nation’s largest insurers. Anthem Blue Cross and Blue Shield announced this quarter that it would apply a 10% penalty to the allowed amount on commercial insurance claims when hospital care is provided by…