A nearly $3 billion settlement with Blue Cross Blue Shield leaves providers with a big choice
Providers that contract with Blue Cross Blue Shield should assess whether they want to participate in a landmark class-action settlement over litigation stemming from complaints about the insurer’s business practices. In October, a resolution reached between provider plaintiffs and Blue Cross Blue Shield Association (BCBSA), along with 33 of its member companies, resulted in a…
New CMS bundled payment initiative may be the future of Medicare
A new bundled payment model, the Transforming Episode Accountability Model (TEAM), marks CMS’s next big step toward its goal of moving 100% of Medicare beneficiaries into value-based care arrangements by 2030. The five-year pilot, announced Sept. 5 and set to launch Jan. 1, 2026, may serve as a blueprint for how CMS manages Medicare coverage…
Medicare, Medicaid are set to cover GLP-1 drugs under a Biden administration proposal
In a major development for Medicare and Medicaid, the Biden administration has issued a proposal for the program to cover a class of weight-loss drugs that have become increasingly prevalent in society. A proposed rule implementing Medicare Advantage and Medicare Part D technical and policy changes for 2026 includes a provision to reinterpret statutory language…
CY 2025 Home Health Prospective Payment System Final Rule Summary
HFMA presents a detailed summary of the final rule published by CMS updating the Home Health Prospective Payment System rates for home health agencies, disposable negative pressure wound therapy devices, and intravenous immune globulin items and services for calendar year 2025.
CY 2025 Physician Fee Schedule Final Rule Summary Part III – Quality Payment Program Updates
HFMA presents part III of three detailed summaries of the final rule relating to the Medicare physician fee schedule for CY 2025 and other revisions to Medicare Part B policies.
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…
CY 2025 Physician Fee Schedule Final Rule Summary Part II – MSSP Requirements
HFMA presents part II of three detailed summaries of the final rule relating to the Medicare physician fee schedule for CY 2025 and other revisions to Medicare Part B policies.
CY 2025 Physician Fee Schedule Final Rule Summary – Part I
HFMA presents a summary of the final rule relating to the Medicare physician fee schedule for CY 2025 and other revisions to Medicare Part B policies. The final rule will be published in the December 9, 2024, issue of the "Federal Register."
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…