Biden’s director of Medicaid expresses concern for the program’s future amid talk of block grants
In what amounted to a valedictory for CMS leadership as it has been constituted during the Biden administration, the head of Medicaid expressed concern about the potential for big changes to the program. Daniel Tsai, director of the Center for Medicaid and CHIP services, said the possible transformation to a block-grant program under the incoming…
HHS watchdog flags improper payments to hospitals for services provided to hospice patients
Hospitals may face closer scrutiny over a segment of Medicare outpatient billing after the HHS Office of Inspector General (OIG) found improper payments. In a report posted Nov. 18, OIG found that improper payments were prevalent for outpatient services provided to hospice enrollees during a five-year period ending in 2021. Examining a sample size of…
2 drug manufacturers go to court to turn 340B into a rebate program
Two leading drug manufacturers have pressed forward with efforts to reformat the 340B Drug Pricing Program, filing lawsuits against the federal government over the question of whether savings can be offered as cash rebates rather than up-front discounts. Johnson & Johnson took HHS and the Health Resources and Services Administration (HRSA) to federal court in…
An eventful period for healthcare policy looms as Trump and GOP members of Congress prepare to govern
Notes: The opening section of this article was updated Nov. 19 with news about the nomination of Mehmet Oz as administrator of CMS. For information on the healthcare policy agenda for the final two months of the current Congress, see the sidebar at the bottom of this page. The results of the 2024 federal elections…
New report: Surging claims denials are undermining working relationships between health systems and health plans
A new report from the Healthcare Financial Management Association reveals that relationships between health systems and health plans have worsened over the past three years, with 80% of surveyed CFOs blaming health plans for increasing denials and claim adjudication errors.
HFMA recognizes 2,075 members who earned certifications in Q3 2024
HFMA now offers 11 certifications for members to validate their expertise and demonstrate their commitment to the profession, including the two recently launched certifications highlighted in bold in the list below. The HFMA certifications are as follows: Multiple certification holders Of the 2,075 people earning certifications in Q3, 101 attained more than one HFMA certification.…
What the site-of-care shift for joint replacement means for hospitals
Hospital patient volumes mostly have been on an upswing since the worst of the COVID-19 pandemic, but certain trends represent cautionary tales for long-term finances. For example, the latest report (registration required) from Strata Decision Technology shows a year-over-year decline in August of more than 21% for inpatient primary knee replacement procedures. A shift to…
HFMA now offers AI Governance Micro-Credential for healthcare finance professionals
As HFMA prepared to introduce its first micro-credential for healthcare finance professionals, we sat down with Todd Nelson, HFMA’s director of professional practice and partner relationships, to learn more. Q: HFMA just came out with its first micro-credential. Can you tell us more about it? Todd Nelson: HFMA launched its first micro-credential training course Nov.…
Medicare’s 2025 payment updates: Why hospitals and physicians think the methodologies are flawed
Neither hospitals nor physicians found much reason for encouragement in final 2025 Medicare payment rules released Nov. 1. The rules, which were made available as pre-publication drafts, finalized a 2.9% increase for hospitals under the payment system for Medicare outpatient services and ambulatory surgical centers (ASCs). Meanwhile, physicians were dealt a 2.83% cut that they…
Senate leaders release a blueprint for comprehensive site-neutral payment policies
To the disappointment of hospital groups, two Senate leaders have produced bipartisan policy options for advancing site-neutral payment in Medicare. The framework released Nov. 1 by Sens. Bill Cassidy (R-La.), who is a physician, and Maggie Hassan (D-N.H.) goes further than site-neutral payment plans that were passed by the House as part of broader healthcare…