Reimbursement

Hospitals should know the cost of providing care so that if they’re losing money on a specific service they can go to payers and renegotiate, says Kelly Arduino, Healthcare Industry Leader at advisory firm Wipfli.

The physician does the prescription in the background, Surescripts asks the PBM for prior auth approval and the information is pulled from the EHR, all within 30 seconds, says Matt Koehler, VP of product innovation at Surescripts.

Underpayment is one of the most damaging issues financially for hospitals reporting that over a year, 32% of claims were underpaid, representing $5B in lost revenue, says John Yount, Chief Innovation Officer, FinThrive.

Hospitals have four months to prepare, says former VA secretary who serves on the board of Sanford Health.

Under the Transforming Episode Accountability Model, starting January 1, 2026, 750 hospitals and other healthcare institutions must provide a retrospective bundled program for episode-based care, says Dave Snow, CEO of Cedar Gate Technologies.

Real-world encounter data shows MA enrollees have more chronic conditions and greater social risk factors than those in original Medicare, says Inovalon's VP of research science and advanced analytics, Christie Teigland.

CMS is finalizing its proposal to remove four SDOH standardized patient assessment data elements to reduce burden.

The increase is more than the 2.4% proposed in April but remains “insufficient,” says National Alliance for Care at Home.

Total estimated payments to IPFs are expected to increase by 2.4%, or $70 million, next year.

TEAM should not be mandatory, as it puts at risk smaller hospitals unable to support the investment needed, AHA says.