Understanding the signals amid the noise: What’s really happening with Medicare Advantage?
In healthcare circles, the buzz continues: Providers are exiting Medicare Advantage (MA) arrangements in large numbers. An HFMA survey found that 19% of provider organizations stopped accepting one or more MA plans in 2023 with almost 60% of respondents either planning or considering a pause on one or more MA plans in the next 24…
New CMS bundled payment initiative may be the future of Medicare
CMS's Transforming Episode Accountability Model (TEAM) is a new bundled payment model that aims to move Medicare beneficiaries into value-based care arrangements by 2030, and hospitals participating in the model will be financially responsible for the cost and quality of care for five procedures.
HFMA provides a comprehensive, curated list of CMS guidance on the 2-midnight rule/benchmark for use by payers and providers
Health systems nationwide continue to report unjust increases in beneficiary cost-sharing and delays in post-acute care by Medicare Advantage (MA) plans. These delays often result from automatic downgrades that contradict CMS requirements, specifically those relating to the agency’s two-midnight rule/benchmark, which mandates adherence by MA plans to establish agency-directed care standards. Despite the mandate that…
How to respond to Medicare Advantage’s rising headwinds
Medicare Advantage has experienced rapid membership growth, but providers and payers are facing headwinds that are increasing contention and uncertainty, leading to a shift in power and potential implosion of the program.
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…
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…
CY 2025 Physician Fee Schedule Proposed Rule Summary – Part I
HFMA presents Part I of three detailed summaries of the proposed rule relating to the Medicare physician fee schedule for CY 2025 and other revisions to Medicare Part B policies.
Mandatory Medicare bundled payments and respiratory disease reporting are on the way for hospitals
Hospitals in nearly a quarter of U.S. markets soon will be required to participate in a Medicare bundled payment model covering five surgical procedures, CMS said in newly released regulations. The model is among several policies of note in Medicare’s FY25 final rule for hospital inpatient care and long-term care hospitals. See this previous article…
CY 2025 Home Health Prospective Payment System Proposed Rule Summary
HFMA presents a detailed summary of the CY 2025 proposed rule updating payment rates for home health agencies.
Hospitals will get only a small bump in Medicare inpatient payments for FY25
Hospital representatives were less than excited about the rate update in Medicare’s FY25 final rule for inpatient care and long-term care hospitals. Published Aug. 1, the rule includes a 2.9% rate increase for acute care hospitals in the fiscal year that begins Oct. 1. The increase is derived from a 3.4% hike in the market…