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Nearly 15,500 healthcare providers are known to have withdrawn from the record-setting Blue Cross Blue Shield antitrust settlement, retaining the option to pursue separate litigation.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.
Upcoming regulations and budget talks could be consequential for Medicaid supplemental payments
Note: This article was updated May 2. The system of directed payment programs (DPPs) has helped make Medicaid more financially viable for providers, but that system is under increasing political pressure. CMS has queued up a proposed rule that is undergoing a standard review at the Office of Management and Budget (OMB) and then is…
8 best practices for elevating and integrating RA in value-based care
As healthcare organizations work toward meeting CMS’s 2030 implementation goals for value-based care (VBC), RA should be a top concern. Too often, these organizations’ leaders mistakenly believe all that’s needed for success under VBC is to invest in a strong coding department. Many healthcare executives and clinical leaders understand the importance of RA, but they…
340B changes loom as the program attracts congressional, White House scrutiny
Both Congress and the White House are proposing 340B Drug Pricing Program changes that could add administrative burdens and ultimately limit the available savings for hospitals. A new report issued by Republican members of the Senate Health, Education, Labor and Pensions (HELP) Committee calls for changes that include requiring 340B covered entities to “provide detailed…
FY 2026 IPPS/LTCH PPS Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule describing FY 2026 policies and rates for Medicare’s IPPS and LTCH PPS.
2026 Medicare Advantage – Part D Final Rule Summary
HFMA provides a detailed summary of the final rule revising regulations affecting Medicare Advantage, Medicare Prescription Drug Benefit, Medicare cost plans, and Programs of All-Inclusive Care for the Elderly.