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…
An eventful period for healthcare policy looms as Trump and GOP members of Congress prepare to govern
President-elect Donald Trump and congressional Republicans are expected to implement changes to healthcare policy, including site-neutral payment, price transparency, and modifications to Medicare and Medicaid, while the nomination of Robert F. Kennedy Jr. as HHS Secretary and Mehmet Oz as CMS Administrator could have implications for the healthcare system.
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…
Providers’ winning streak in No Surprises Act QPA litigation ends as appeals court overturns a prior ruling
Healthcare providers incurred a rare defeat in litigation over a key facet of the No Surprises Act, with an appeals court ruling that the original methodology for calculating the qualifying payment amount (QPA) is permissible. The Oct. 30 decision restores language from prior regulations and means insurers can continue to incorporate or exclude certain disputed…
FY 2025 IPPS/LTCH PPS Interim Final Rule Summary
HFMA presents a detailed summary of the interim final rule with comment published by CMS in the October 3, 2024, Federal Register revising its previously announced FY 2025 policies and rates for Medicare’s IPPS and LTCH PPS.