Hospitals brace for leaner contracts as Medicare Advantage plans face financial pressures
A projected drop in Medicare Advantage enrollment and cuts in plan availability could negatively impact hospitals and health systems.| HFMA
In 2006, two renowned researchers introduced “The Value Equation” for healthcare: Value = Quality/Cost. It was the first step toward bringing the healthcare industry together in acknowledgingtwo of the industry’s ugly truths. Costs of care were outpacing the quality of carereceived, yet the healthcare system was built around a fee-for-service payment modelthat rewarded providers for… The post Value-based care adoption grows, but challenges remain appeared first on HFMA.| HFMA
HFMA presents this executive summary of the CMS interim final rule providing additional flexibilities to Medicare and Medicaid regulations during the COVID-19 pandemic. The post HFMA Executive Summary: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency appeared first on HFMA.| HFMA
HFMA summarized HHS/DOL/IRS FAQs on cost sharing for COVID-19 testing and related services. The post HFMA Summary of HHS/DOL/IRS FAQ on Cost Sharing for COVID-19 Testing and Related Services appeared first on HFMA.| HFMA
Highlights of interim final rule that, for the duration of the COVID-19 public health emergency (PHE), offers providers flexibility by reinterpreting regulations. The post Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency: HFMA Executive Summary appeared first on HFMA.| HFMA
This document contains a detailed summary of the provisions in the Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security (CARES) Act. The post Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security (CARES) Act Summary appeared first on HFMA.| HFMA
HFMA presents a detailed Summary of the OIG’s federal anti-kickback statute and civil monetary penalty final rule, published in the December 2, 2020, Federal Register. The post Anti-Kickback Statute and Civil Monetary Penalty Final Rule Summary appeared first on HFMA.| HFMA
HFMA presents a summary of the final rule updating the regulations implementing the physician self-referral law, published by CMS in the December 2, 2020, Federal Register. The post Physician Self-Referral Final Rule Summary appeared first on HFMA.| HFMA
HFMA summarized in detail the OIG's proposed rule amending its civil money penalty regulations. The post OIG Civil Money Penalty Amendment Proposed Rule Summary appeared first on HFMA.| HFMA
This document summarizes the proposed rule published by the OIG in the October 17, 2019, Federal Register, to revise safe harbors under the federal anti-kickback statute and the civil monetary penalty law that prohibits inducements offered to patients. The post Anti-Kickback Statute and Civil Monetary Penalty Proposed Rule Summary appeared first on HFMA.| HFMA
This document summarizes the proposed rule updating regulations implementing the physician self-referral law, published by CMS in the October 17, 2019, Federal Register.| HFMA
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Hospital merger-and-acquisition (M&A) activity accelerated in Q3 2025, indicating that executive teams are getting a handle on the prospective impact of major healthcare policies. “Now that the One Big Beautiful Bill has passed, hospitals and health systems have more policy clarity to inform their growth strategies,” Anu Singh, managing director at Kaufman Hall, which published… The post Hospital merger tally increases as organizations come to grips with the policy environment appeared ...| HFMA
HFMA’s FastFinance newsletter is now a podcast. Host Rich Daly discusses the most current and relevant healthcare news, delivered in an easily digestible format. Congress is pressing CMS to release long-delayed rules that would implement requirements that providers create good faith estimates for their patients. Also, this week’s Weird Number: As of July, 96.5% of… The post FastFinance: Good faith estimate rules coming appeared first on HFMA.| HFMA
Vulnerabilities in the supply chain for pharmaceuticals are putting patients at risk and hampering healthcare providers, according to testimony at a recent Senate hearing. The flaws manifest in shortages of vital drugs and in issues of quality and transparency, experts said during the Oct. 8 hearing of the Senate Special Committee on Aging. In Q1… The post Senate committee examines ways to strengthen the supply chain for hospital drugs appeared first on HFMA.| HFMA
The Health Transformation Alliance (HTA) has identified three approaches that have saved its member companies the most in healthcare expenditures, including switching to TPAs, shifting to a full pass-through pharmacy benefit manager, and pushing payment integrity. The post Employers find success in healthcare savings through TPA shift and payment integrity appeared first on HFMA.| HFMA
CMS is expected to implement long-delayed transparency rules for payers and providers, including Good Faith Estimates and Advanced Explanation of Benefits, in 2026, after years of pressure from Congress and industry stakeholders. The post Congress pressures CMS to implement No Surprises Act requirements appeared first on HFMA.| HFMA
Some hospitals that received funding support from HHS during the COVID-19 pandemic may need to prepare for additional auditing based on findings of a report by the department’s Office of Inspector General (OIG). The report examined a small sampling of Provider Relief Fund (PRF) recipients and found that 17 of 25 hospitals did not comply… The post OIG report could lead to additional inspection of hospitals’ Provider Relief Fund usage appeared first on HFMA.| HFMA
Administrative costs in healthcare continue to rise, often consuming more resources than direct patient care. Nowhere is this more visible, or more solvable, than within revenue cycle management (RCM). These costs are not just a patient care concern; they strain the workforce and directly impact financial sustainability. Much of the challenge stems from a persistent… The post Cutting through the clutter: Practical strategies to reduce administrative waste in payer-provider interactions appe...| HFMA
This report explores the accounts payable (AP) automation opportunity by examining two tools with proven effectiveness and ease of implementation. Download the white paper to uncover these resources. The post Accounts Payable Automation in Action appeared first on HFMA.| HFMA
UMass Memorial Medical Center’s radiology department has been able to sidestep a lack of bill coding professionals by adopting AI in the medical center’s coding for radiology. “It’s really hard to get certified coders these days,” said Barbara Scully, associate vice president, physician billing with UMass Memorial, which is located in Worcester, Massachusetts. “It’s one… The post AI coding at UMass Memorial tempers staffing shortage appeared first on HFMA.| HFMA
A projected drop in Medicare Advantage enrollment and cuts in plan availability could negatively impact hospitals and health systems.| HFMA
According to new survey data, of 272 healthcare directors, presidents, CFOs, managers and other members of HFMA, 90% believe that with human oversight, technologies like automation and AI will improve financial performance effectively. Review this research report for prospective workflows and common barriers.| HFMA
Healthcare finance leaders can utilize this white paper to guide them with actionable strategies to uncover and control hidden telecom costs amid 2025's financial pressures.| HFMA
Uncompensated care costs have risen sharply, but hospital incomes have also increased. Bad debt and charity care are growing faster than revenue.| HFMA
The Medicare drug negotiation law has led to higher out-of-pocket costs for many Medicaid enrollees, according to recent research.| HFMA
This tool empowers healthcare leaders to make smart, intentional choices that align with their mission, support operational and financial performance, and prepare their organization for what’s next.| HFMA
New research shows that patients are paying less out-of-pocket costs for healthcare. Mean repayment rates have decreased, with more patients paying nothing.| HFMA
Revenue cycle management (RCM) is essential for positive patient experiences and efficient financial operations in hospitals. See the process and HFMA resources here.| HFMA
An initiative aimed at addressing the needs of revenue cycle staff has enabled a health system to inspire high levels of engagement.| HFMA
The Healthcare Financial Management Association (HFMA) equips its members to navigate a complex healthcare landscape. Healthcare finance professionals trust HFMA to provide the guidance and tools to help them lead their organizations, and the industry, forward.| HFMA
A healthcare system without regulations would be catastrophic. But provider organizations are now burdened with managing compliance under increasingly complex requirement.| HFMA
