HFMA Comments on Revisions to Payment Policies under the CY 2026 Medicare PFS, Quality Payment Program and Other Revisions to Part B
HFMA submits comments pertaining to Proposed Rule CMS-1832-P Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2026.
CMS gives updates on upcoming Medicaid state-directed payment limits
CMS has issued guidance to Medicaid programs about implementing required restrictions on the state-directed payments (SDPs) made through Medicaid managed care organizations (MCOs). The budget reconciliation law known as the One Big Beautiful Bill Act (OBBBA) includes a provision that all SDPs submitted after July 4 for hospitals must be limited to the Medicare rate…
Senate, House release diverging HHS budget proposals for FY26 (updated-2)
Note: This article was updated Sept. 16 with news about a short-term continuing funding resolution and Sept. 10 with new numbers for some provisions in the House appropriations bill. Sept. 16 update Republicans in the House are focusing on a short-term continuation of FY25 federal funding as the most direct route to avoiding a partial…
FY 2026 Hospice Payment Rate Update Final Rule Summary
HFMA presents a detailed summary of the final rule updating the Medicare hospice payment rates, wage index, and Hospice Quality Reporting Program for FY 2026.
Court limits CMS’s authority to immediately apply the ACA marketplace program integrity final rule
A federal judge blocked many of the Trump administration’s plans to constrict enrollment in Affordable Care Act (ACA) marketplace health plans in the name of program integrity. In an Aug. 22 ruling, Judge Brendan Hurson (a Biden appointee) of the U.S. District Court for Maryland issued a stay of key provisions of a CMS final…
Rethinking rev cycle, plus the 2026 Medicare proposed rule on physician fee schedule
Mayank Pant from IKS Health talks about why healthcare organizations haven’t been able to overcome longstanding challenges, and Nick Hut talks with HFMA Policy Director Katie Gilfillan about the 2026 Medicare Proposed Rule on physician fee schedule.
CY 2026 Physician Fee Schedule Proposed Rule Summary Part III – Quality Payment Program Updates
HFMA presents part III of three detailed summaries of the proposed rule relating to the Medicare physician fee schedule for CY 2026 and other revisions to Medicare Part B policies.
CBO breaks down how and when the budget reconciliation bill will reduce insurance enrollment
The Congressional Budget Office (CBO) released its most detailed projections yet about how the budget reconciliation bill stands to affect healthcare coverage. According to data published Aug. 11 as part of a report requested by Democratic congressional leaders, the CBO estimates that 10 million people will be uninsured in 2034 because of the new law.…
CY 2026 Proposed OPPS APC/HCPCS Lookup Tool
This spreadsheet is a tool that allows the user to pull-up basic descriptive and payment information for an APC or HCPCS code. The Proposed OPPS APC/HCPCS lookup tool spreadsheet contains the following tabs:
Comparison of Proposed 2026 OPPS Addendum B with July 2025 Addendum B
This spreadsheet compares relative weights and payment rates at the HCPCS level, using 2026 OPPS proposed rule Addendum B compared to 2025 Addendum B (July 1, 2025 file), as downloaded from the CMS website. Spreadsheet cells highlighted in yellow were calculated by HFMA; all other information is from CMS. The Addendum B spreadsheet contains these…