Healthcare payment policy and regulation
Payment policy and regulation encompasses the various rules, guidelines and laws governing healthcare's financial aspects, including Medicare and Medicaid reimbursement rates, medical billing, and claims administration. Payment policy and regulation also plays a critical role in shaping the healthcare landscape, affecting service accessibility and affordability.
Top Stories
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02 Jul 2026
CMS takes aim at 340B, site-neural payments in OPPS proposal
The proposed Hospital Outpatient Prospective Payment System rule also includes a 2.4% rate boost, prior authorization for Botox injections and a more aggressive 340B remedy plan. Continue Reading
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01 Jul 2026
Elevance: No Surprises Act IDR awards hit 'extreme' levels for OR
Providers are winning 90% of payment disputes for planned procedures with awards up to 119 times typical rates, raising questions about the No Surprises Act's impact. Continue Reading
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20 Jan 2020
DoJ Recovered $2.6B from Healthcare Fraud Cases in 2019
Of the more $3 billion in settlements and judgments recovered by the department in 2019, $2.6 billion stemmed from healthcare fraud cases. Continue Reading
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16 Jan 2020
Cost Disparities Spell Trouble for Healthcare Price Transparency
Crowe found a 297% difference between the lowest and highest gross charge in individual hospital procedures, showing potential issues in the healthcare price transparency order. Continue Reading
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15 Jan 2020
GAO Calls for More Oversight of 340B Drug Pricing Program
Processes for determining nongovernmental hospital eligibility for the 340B Drug Pricing Program fail to identify hospitals without valid contracts, GAO reports. Continue Reading
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15 Jan 2020
AHA, AAMC Sue HHS Again Over Outpatient Site-Neutral Payments
The associations along with several member hospitals are looking to block outpatient site-neutral payments in 2020 following their successful lawsuit last year. Continue Reading
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14 Jan 2020
1 in 3 Rural Adults Report Issues Affording Medical Bills
32% of rural adults reported problems paying dental and medical bills, including 19% saying they have major affordability problems, a JAMA study reveals. Continue Reading
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09 Jan 2020
US Administrative Healthcare Spending Reached $812B in 2017
Administrative expenditures represented about one-third of total healthcare spending in the US, twice the amount in Canada, a new study finds. Continue Reading
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09 Jan 2020
Childbirth Complications Boost Hospital Costs by 20%
Complications including SMM, behavioral health disorders, diabetes, and chronic pain raise hospital costs by 20% and increase mothers’ hospital stay by 70-75%. Continue Reading
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07 Jan 2020
Beaumont Health Signs $6.1B Hospital Merger Deal with Summa Health
The hospital merger agreement will allow both organizations to boost capital and drive growth as well as enhance quality of care for individuals and communities. Continue Reading
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07 Jan 2020
Former Anthem Exec to Lead CMMI, Value-Based Care Efforts at HHS
Brad Smith, the former COO of Anthem’s Diversified Business Group, will serve as director of CMMI and senior advisor to Secretary Azar for value-based care. Continue Reading
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06 Jan 2020
AMA Offers Checklist for E/M Coding and Documentation Changes
The checklist gives physician practice tips on how to manage E/M coding and documentation changes in order to maximize burden relief. Continue Reading
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03 Jan 2020
Medical Groups Worry About Risk in Anti-Kickback, Stark Law Reform
Policy alignment, financial risk threshold modification, and overall flexibility will help tackle concerns surrounding proposed Anti-Kickback Statute and Stark Law reform, medical groups say. Continue Reading
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02 Jan 2020
PhrMA: 340B Hospitals Reimbursed 3X the Amount Paid for Drugs
The pharmaceutical industry group reported that, on average, 340B hospitals paid $1,591 per claim and received $4,673 in reimbursement. Continue Reading
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15 Nov 2019
New Healthcare Price Transparency Rule to Unveil Negotiated Rates
A final healthcare price transparency rule from HHS will require hospitals to post payer-specific negotiated rates and other charges by 2021. Continue Reading
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18 Jun 2019
MedPAC Suggests Elimination of Incident To Billing for APRNs, PAs
In addition to concerns about incident to billing, the commission also advised CMS to use a stay-based design for a unified post-acute care payment system and establish national ED coding guidelines. Continue Reading
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26 Jul 2018
Verma: Healthcare Payment Reform to Focus on Docs, Not Hospitals
Site-neutral payments, capitated reimbursement, and competitive bidding were among the provider-focused healthcare payment reforms suggested by CMS leader Seema Verma. Continue Reading
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05 Sep 2017
CMS Offers Value-Based Purchasing Exceptions After Hurricane Harvey
Providers in 32 Texas counties and five Louisiana parishes will be exempt from value-based purchasing and quality reporting requirements because of Hurricane Harvey. Continue Reading
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11 Aug 2015
ICD-1 to ICD-11 Timeline Highlights Healthcare’s Evolution
From ICD-9’s inception via The World Health Organization over 35 years ago to ICD-10’s kick-off this upcoming October, how far has the healthcare industry come? Continue Reading
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20 Feb 2015
Why Recent Attempts at Healthcare Reform Regulation Matter
Value-based care is buzzing among healthcare organizations. With new federal healthcare reform in effect, value-based care takes on new form in HHS news. Continue Reading
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09 Dec 2014
HIPAA Compliance within Revenue Cycle Management
The inclusion of HIPAA transactions intends to reduce administrative costs, but to do so, medical practices must strengthen their revenue cycle management. Continue Reading