Per the new interim final rule, parties that cannot agree on out-of-network payment rates must enter into a 30-day open negotiation period. If that fails, an independent entity will be engaged to make the final decision.
After pushing back the start date twice, CMS now wants to scrap the Trump-era rule, which provides an expedited pathway to Medicare coverage for devices that receive the FDA breakthrough designation.
Balancing healthcare benefits and insurance costs requires research. From becoming a Difference Card member to offering wellness resources, there are many ways to improve healthcare at low cost.
The permanent injunction prevents HHS from interpreting a section of the ACA, which bans discrimination, to include gender identity and pregnancy status. This move prohibits the federal agency from penalizing religious providers for refusing to perform or provide insurance coverage for gender-transition surgeries and abortions.
Following several legal battles and opposition from providers, CMS is proposing nixing the Most Favored Nation Model, which matches payments for Medicare Part B drugs to the lowest price paid by other wealthy countries.
HHS, along with other federal agencies, have released the first set of regulations that ban surprise billing and out-of-network charges for several types of services. More regulations are expected, especially those pertaining to the independent dispute resolution process that providers and payers will have to undergo if they cannot agree on out-of-network claims payment.
Though the price transparency rule aims to make it easier for healthcare consumers to compare prices, there is a lack of standardization in how hospitals present the data, making it hard for consumers to shop around for care, a new analysis shows.
Mike Wirth of ProviderTrust shares insights about the company in this interview at the ViVE 2025 conference in Nashville last month.
The federal price transparency rule for hospitals went into effect Jan. 1, but a new analysis shows that a majority of providers studied were "unambiguously noncompliant."
The agency has finalized a rule that allows it to provide immediate Medicare coverage for FDA-approved products that are deemed "breakthrough devices." The new coverage process would enable seniors to get access to these devices more quickly, but some provider and payer groups are concerned that this could cause patient harm.
A federal appeals court has ruled against hospital groups in their legal challenge to the CMS regulation that would require hospitals to make pricing information publicly available. The rule is set to take effect Jan. 1.
The American Hospital Association and several other entities, including some hospitals, filed an emergency motion to block CMS from enforcing the hospital price transparency rule set to take effect Jan. 1. Provider groups are arguing that complying with the rule would shift focus away from pandemic-related efforts.
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The rule would require payers in the Medicaid, CHIP and QHP programs to build and maintain application programing interfaces to improve data exchange and the prior authorization process. But the rule does not include Medicare Advantage plans, which the American Hospital Association called "disappointing."
The final rule requires insurers to disclose information on prices for healthcare services and cost-sharing with patients. The government says it will help lower prices, but insurers aren't so sure.
CMS' interim rule states that Medicare will cover Covid-19 vaccines approved by the FDA, including those receiving emergency use authorization, in a reversal from its usual policy. The vaccine will be made available at no cost to Medicare beneficiaries.