Aetna’s new payment policy could leave hospitals at a disadvantage
Hospitals should take note of an insurer’s new approach regarding the two-midnight rule, especially given the potential implications if the policy becomes widely adopted. In a recent communication, Aetna said providers that contract with the company’s Medicare Advantage (MA) plans and Medicare Special Needs Plans face a new policy beginning Nov. 15 in instances when…
Comparison of Proposed 2026 OPPS Addendum A with July 2025 Addendum A
HFMA presents a spreadsheet comparing relative weights and payment rates at the APC level, using the 2026 OPPS proposed rule Addendum A compared to 2025 Addendum A.
News Briefs: Budget reconciliation bill finalized with big implications for Medicaid
Declines in coverage and spending await the healthcare industry under the budget reconciliation bill signed into law by President Donald Trump on July 4. The Congressional Budget Office (CBO) projects $912 billion in reduced Medicaid spending and 10 million additional uninsured Americans in 2034 as a result of the law known as the One Big…
Medicare final rule brings a mixed bag for FY26 hospital inpatient payments
Hospitals collectively will receive a base payment increase of 2.6% in Medicare reimbursement for inpatient care provided in FY26, according to a newly published final rule. It’s a somewhat uneventful set of regulations compared with the recently released 2026 proposed rule for Medicare outpatient payments. But hospitals were hoping for a bigger inpatient update, with…
CY 2026 OPPS/ASC Proposed Rule Summary
HFMA presents a detailed summary of the CY 2026 proposed rule updating OPPS payment policies that apply to outpatient services provided to Medicare beneficiaries and annual updates to the ambulatory surgical center payment system.
CY 2026 Physician Fee Schedule Proposed Rule Summary Part II – MSSP Requirements
HFMA presents part II 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.
CY 2026 Physician Fee Schedule Proposed Rule Summary – Part I
HFMA presents part I 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.
In comments, for-profit hospital leaders don’t dwell on ‘Big Beautiful Bill’ impact
Leaders of for-profit hospital chains ranged from noncommittal to confident in recent remarks about impending rollbacks to Medicaid and the Affordable Care Act (ACA). Hospitals have several years to prepare for some of the changes, and the interval also leaves time to modify policies in the newly passed budget reconciliation bill, health system leaders said…
Perils and promise of Medicare Advantage highlighted at congressional hearing
Testimony during a congressional hearing this week highlighted the strain hospitals are experiencing from the administrative roadblocks posed by Medicare Advantage (MA). For all the potential seen in the program to improve health and care delivery, MA is not working the way it should, several industry experts acknowledged during the July 22 joint hearing of…
The latest on providers’ landmark antitrust suit alleging price fixing by MultiPlan and healthcare insurers
Billions of dollars are at issue in an ongoing lawsuit in which providers allege price fixing by a vendor and a large segment of the health insurance industry. Providers bringing the suit maintain that the healthcare technology solutions company MultiPlan and roughly 700 health plans conspired to suppress reimbursement for out-of-network services over a decade…