Medicare administrative contractor news includes a data breach and potential consolidation
Recent happenings involving Medicare administrative contractors (MACs) include a notice of a data breach and a request for feedback on possible consolidation. CMS sent out word that nearly 950,000 Medicare beneficiaries whose claims go through Wisconsin Physicians Service Insurance Corporation (WPS) are being informed that their protected health information or other personally identifiable information may…
HHS concedes defeat in litigation over providers’ use of tracking technologies on websites
The hospital lobby cemented its victory in litigation about online tracking tools after HHS canceled its planned appeal. In June, the American Hospital Association (AHA) and co-plaintiffs won a decision in a Texas federal court about 2022 guidance (revised and somewhat softened in 2024) instructing hospitals and other HIPAA-covered entities to avoid using online tracking…
Congress only has a few more months to ensure expansive telehealth access continues (updated)
Note: This article was updated Sept. 18 and Sept. 19 with information about new telehealth legislation. See the updates below. The clock is ticking on efforts to maintain the telehealth flexibilities that have been in place since the start of the COVID-19 pandemic, with advocates hoping Congress will act before year’s end. Key waivers will…
ONC issues proposed technical standards to improve health information sharing
Proposed regulations bring healthcare providers and patients a step closer to gaining access to key health information stored in payer databases. Provisions in a proposed rule published Aug. 5 by the Office of the National Coordinator for Health Information Technology (ONC) support a CMS final rule released in 2020 and another issued early this year,…
Johnson & Johnson looks to make a big change in how hospitals obtain 340B price discounts (updated-2)
Note: This article was most recently updated Oct. 1 with information on Johnson & Johnson’s change of plans regarding a proposed 340B rebate program. See that update below. A leading drug manufacturer opened a new chapter in the fight with hospitals over the 340B Drug Pricing Program, requiring the use of a rebate program to…
A key election question: What will happen to the enhanced Affordable Care Act subsidies?
Earl Pomeroy knows from experience that the politics surrounding the Affordable Care Act (ACA) are dicey. As a Democratic member of the House Ways and Means Committee, Pomeroy helped pass the ACA during his ninth term representing North Dakota. After that, “I lost my job,” he recalled. Since his time in Congress ended with his…
The financial state of the not-for-profit hospital sector: key takeaways from the latest medians
The financial condition of the U.S. not-for-profit (NFP) hospital industry can be described as steadily improving but still struggling, according to insights from two of the three main credit-rating agencies. Fitch Ratings and S&P Global both recently issued reports on sector medians, using audited data from 2023. The companies described an industry that has rebounded…
Hospitals see a margin advantage as care migrates to the outpatient department
The site-of-care shift toward the outpatient setting increasingly is manifesting in margin per case, according to recent financial data. “While overall margins for both inpatient and outpatient hip and knee replacement surgeries have declined, outpatient procedures now have higher margins than inpatient procedures,” Strata Decision Technology wrote in its Performance Trends Report for Q2 (registration…
CMS announces negotiated Medicare Part D drug prices, looks to blunt a potential spike in premiums (updated)
Note: This article was updated Oct. 2 with news about 2025 projected Part D premiums. See the update below. CMS announced the first set of negotiated drug prices under the Inflation Reduction Act (IRA) and recently moved to head off a significant premium increase that’s projected to arise due to provisions in the 2022 law.…
Hospital revenue is enhanced by state-directed Medicaid payments, health systems report
State-directed supplemental payments made through Medicaid are a growing source of hospital revenue, according to financial reporting from the for-profit hospital sector. In reporting their Q2 financials, several of the nation’s largest health systems cited Medicaid supplemental payments as a boost. State-directed payments are a relatively new form of those payments, applying to Medicaid managed…