CMS announces process change for short-stay inpatient claim reviews in Medicare
Recent CMS directives for hospitals include a process change regarding Medicare patient status reviews. Beginning Sept. 1, Medicare administrative contractors (MACs) will conduct the reviews used to determine the appropriateness of Part A payment for adjudicated short-stay inpatient hospital claims. The reviews to date have been conducted by Beneficiary and Family Centered Care Quality Improvement…
House passes budget reconciliation bill that would dramatically affect healthcare coverage
June 10 update: The article was updated with news from the White House about Medicaid state-directed payments. June 4 update: The article was updated with the Congressional Budget Office’s formal score of the legislation passed by the House. A sweeping federal policy bill that includes major changes to Medicaid is halfway toward becoming law after…
Budget reconciliation bill faces a rocky road as Medicaid and ACA cuts draw provider concerns
In the days after a key House committee approved legislation that includes substantial cuts to Medicaid funding, the bill’s path forward remained full of obstacles. The healthcare portion of the budget reconciliation bill passed the Energy and Commerce Committee on a party-line 30-24 vote May 14. Since then, reports from Capitol Hill have detailed the…
RFK Jr. defends HHS budget to Congress and talks Medicaid, 340B and more
In congressional testimony, HHS Secretary Robert F. Kennedy Jr. endorsed proposed Medicaid cuts as affecting fraud, waste and abuse rather than beneficiaries who most need the program. Speaking May 14 before a House Appropriations subcommittee and later the Senate Health, Education, Labor and Pensions (HELP) Committee, Kennedy also indicated a willingness to pare down the…
Medicaid provider payments take a hit in budget reconciliation bill
As released over the weekend, formalized plans to reduce federal Medicaid spending would have an impact on future state-directed supplemental payments and other aspects of the program. The House Energy and Commerce (E&C) Committee published its portion of a budget reconciliation bill that would slash 10-year projected federal spending. As expected, Medicaid would incur the…
Providers, payers both struggle with Medicare Advantage challenges
Note: This article was updated May 13 where noted. Neither providers nor a leading payer are finding much reason for satisfaction with the state of Medicare Advantage (MA) these days. Q1 financial reporting by for-profit hospital chains and by UnitedHealth Group (UHG), among other payers, have reflected the challenging landscape. UHG in April shared what…
Trump proposes big spending cuts to healthcare programs
President Donald Trump’s FY26 budget proposal includes significant cuts to healthcare programs, but the administration says the reductions will not affect core services. The budget is merely a set of recommendations, given that federal budgetary authority resides with Congress. Trump’s proposals are likely to hold influence with the narrow Republican majorities in both chambers, but…
Blue Cross Blue Shield settlement concerns linger as date of final approval nears
Nearly 15,500 healthcare providers are known to have withdrawn from the record-setting Blue Cross Blue Shield antitrust settlement, retaining the option to pursue separate litigation. The number was listed in an April court filing as the parties move toward a July 29 hearing at which the presiding court is scheduled to consider final approval of…
Supreme Court: HHS can maintain DSH formula approach that results in lower payments
The Supreme Court dealt hospitals a loss in a case about Medicare disproportionate share hospital (DSH) payments, saying HHS can continue using a disputed interpretation of the payment formula. Published April 29, a 7-2 decision for the federal government in Advocate Christ Medical Center, et al. v. Kennedy allows for continuation of a policy whereby…
FY 2026 Inpatient Psychiatric Facilities PPS Proposed Rule Summary
HFMA presents a detailed summary of the FY 2026 Inpatient Psychiatric Facilities PPS proposed rule, released by CMS on April 11, 2025.