How hospitals can prepare for heightened 340B oversight
Momentous change may be looming for the 340B Drug Pricing Program, currently managed by the Health Resources & Services Administration (HRSA). An ongoing debate regarding the program’s effectiveness reflects broad concerns regarding transparency, oversight and program integrity. At the center of the debate are questions about implementation of HRSA’s 340B Rebate Model Pilot Program. Although…
Frictionless payment, post-claim resolution and the move to value
HFMA Senior Editor Erika Grotto shares conversations with three sponsors from HFMA’s Annual Conference. This episode includes: * Adam Cartabiano from Knowtion Health talking about post-claim resolution and AI in the revenue cycle. * Jessica Gerow from Zelis discussing payment modernization that goes beyond ACH. * Jeffrey Palmieri and Cindy Clark from Huntington Bank share…
The State of Payer Negotiations: Data, Visibility and Financial Performance
Drawing on responses from 161 provider organizations, this report benchmarks how healthcare leaders are approaching payer negotiations and reimbursement management. Download this white paper to review opportunities to improve visibility, strengthen financial performance, and make better-informed contracting decisions.
New data on No Surprises Act IDR cases show providers won often in 2025
Providers and their intermediaries continued to flourish in the No Surprises Act’s independent dispute resolution (IDR) process during the second half of 2025, according to newly released data from the federal departments overseeing IDR. Among 1.15 million disputes that received payment determinations during the six-month period, providers won 85%. That share generally tracked trends seen…
Comparison of Proposed 2027 OPPS Addendum B with July 2026 Addendum B
HFMA provides a spreadsheet comparing relative weights and payment rates at the HCPCS level, using proposed rule Addendum B compared to 2026 Addendum B.
CY 2027 Proposed OPPS APC/HCPCS Lookup Tool
HFMA provides a spreadsheet that is an OPPS APC/HCPCS lookup tool that allows the user to pull-up basic descriptive and payment information for a code.
CY 2027 Physician Fee Schedule Proposed Rule Summary – Part I
HFMA presents part I of three detailed summaries of a prosed rule relating to the Medicare physician fee schedule for CY 2027 and other revisions to Medicare Part B. policies. Part I covers sections I through III.I (except for Section III.G: Medicare Shared Savings Program Requirements) and the Regulatory Impact Analysis.
Comparison of Proposed 2027 OPPS Addendum A with July 2026 Addendum A
HFMA provides a spreadsheet comparing relative weights and payment rates at the APC level, using the 2027 OPPS proposed rule Addendum A compared to 2026 Addendum A.
Medicaid provider tax proposed rule could cut payments by $220 billion over 10 years
A proposed rule from CMS implements anticipated changes to the system of provider taxes that help fund supplemental reimbursement in Medicaid. The changes are required under the One Big Beautiful Bill Act (OBBBA, also referred to as the Working Families Tax Cut legislation), with the proposed rule filling in details. The repercussions of the rule…
MultiPlan antitrust litigation gains momentum after rulings for providers
Healthcare providers obtained two favorable rulings over the last month in their massive antitrust litigation against a vendor’s repricing algorithm. The case entails allegations that MultiPlan — which since has rebranded as Claritev — conspired to set out-of-network (OON) payment rates by gathering competitively sensitive information from roughly 700 health plans and using that information…