Reimbursement

CMS says it considered comments after proposing a 0.09% increase in the Advance Notice.

CMS estimates the revisions will increase federal spending by $18.6 billion over the next decade.

Insurers denied more claims on clinical grounds in 2025 compared with 2024, says new report.

The hospitals want DSH calculations changed back to a pre-2004 standard and payment of additional amounts, plus interest.

Hospitals are on the receiving end of patients coming through the door who don't have the funds to cover services, says Seth Cohen, president of Cedar.

The large New York City hospital system used its market power to restrict contacts with insurers, insulating it from price competition, or "erosion of rates of payment," says DOJ.

KFF survey shows the effect of the expiration of enhanced premium tax credits at the end of 2025.

CMS is leveraging AI and machine learning to flag possible Medicare and Medicaid fraud. However, COO Kimberly Brandt says experts like clinicians and forensic accountants are needed to verify their findings before action is taken.

The three-year elimination of the Medicare Inpatient-Only list began in January with the removal of 285 mostly musculoskeletal procedures, says Allison Oakes, chief research officer for Trilliant.

David Banks, president and CEO of AdventHealth, will address how hospitals can reframe challenges into next steps.