CY 2026 OPPS/ASC Proposed Rule Summary
HFMA presents a detailed summary of the CY 2026 proposed rule updating OPPS payment policies that apply to outpatient services provided to Medicare beneficiaries and annual updates to the ambulatory surgical center payment system.
CY 2026 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 2026 and other revisions to Medicare Part B policies.
CY 2026 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 2026 and other revisions to Medicare Part B policies.
In comments, for-profit hospital leaders don’t dwell on ‘Big Beautiful Bill’ impact
Leaders of for-profit hospital chains ranged from noncommittal to confident in recent remarks about impending rollbacks to Medicaid and the Affordable Care Act (ACA). Hospitals have several years to prepare for some of the changes, and the interval also leaves time to modify policies in the newly passed budget reconciliation bill, health system leaders said…
Perils and promise of Medicare Advantage highlighted at congressional hearing
Testimony during a congressional hearing this week highlighted the strain hospitals are experiencing from the administrative roadblocks posed by Medicare Advantage (MA). For all the potential seen in the program to improve health and care delivery, MA is not working the way it should, several industry experts acknowledged during the July 22 joint hearing of…
The latest on providers’ landmark antitrust suit alleging price fixing by MultiPlan and healthcare insurers
Billions of dollars are at issue in an ongoing lawsuit in which providers allege price fixing by a vendor and a large segment of the health insurance industry. Providers bringing the suit maintain that the healthcare technology solutions company MultiPlan and roughly 700 health plans conspired to suppress reimbursement for out-of-network services over a decade…
Proposed Medicare hospital payment rule includes a surprising cut
Although payment rates technically would increase under Medicare’s 2026 proposed rule for hospital outpatient care, various provisions would chip away at the finances of hospitals and health systems. Specifically, key provisions would equalize certain site-based payments and also accelerate a planned across-the-board payment decrease related to 2022 remedy payments that were made to 340B Drug…
In proposed Medicare physician payment rule, CMS emphasizes Trump administration priorities
Medicare’s 2026 proposed rule for physicians is a key early chance for the Trump administration to shape U.S. healthcare policy in alignment with HHS Secretary Robert F. Kennedy Jr.’s Make America Healthy Again approach. Some of the most noteworthy provisions thus represent an effort to shift resources to primary care and prevention and to crack…
Constriction looms for a key segment of healthcare coverage
The reverberations for Medicaid have drawn most of the recent headlines, but federal policy developments also portend a big contraction of the individual-insurance market in 2026 and beyond. Although group coverage remains the predominant form in the U.S., the market for individual plans has been growing amid recent surges in Affordable Care Act (ACA) enrollment.…
How the reconciliation bill will shake out for hospitals and the healthcare industry
Note: The opening section of this article was rewritten July 23 to account for an updated estimate by the Congressional Budget Office. Declines in coverage and spending await the healthcare industry under the budget reconciliation bill signed into law by President Donald Trump on July 4, but the immediate consequences could be muted. Since passage…