Comparison of Proposed 2025 OPPS Addendum A with July 2024 Addendum A
HFMA presents a spreadsheet comparing relative weights and payment rates at the APC level, using the 2025 proposed rule Addendum A, compared to 2024 Addendum A.
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.
MedPAC starts to scrutinize the costs of outpatient coinsurance at critical access hospitals
At the nation’s nearly 1,400 critical access hospitals (CAHs), cost-sharing payments incurred by Medicare beneficiaries for outpatient services are onerous enough that a new methodology warrants consideration, according to a recent policy discussion. The Medicare Payment Advisory Commission (MedPAC) examined the issue at its September meeting, reporting that beneficiary coinsurance for CAH outpatient care equates…
New federal rule means big changes in coverage of behavioral healthcare
Landmark regulations issued by the Biden administration are intended to establish coverage parity for behavioral healthcare services. A newly published final rule prohibits group health plans, along with health insurers offering group or individual insurance coverage, from restricting access to mental-health and substance-use disorder (SUD) benefits as compared with medical and surgical benefits. The rule,…
Information Blocking Disincentives for Certain Health Care Providers Final Rule Summary
HFMA presents a detailed summary of the final rule establishing disincentives for certain Medicare-enrolled health care providers and suppliers that are found to have committed information blocking.
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…
CY 2025 Physician Fee Schedule Proposed Rule Summary Part II – MSSP Requirements
HFMA presents part II 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.
CY 2025 Physician Fee Schedule Proposed Rule Summary Part III – Quality Payment Program Updates
HFMA presents part III 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. Part III covers the updates to the Quality Payment Program.
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…
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…