Healthcare Financial Management

CMS has canceled roughly 315,000 enrollments encompassing 760,000 people in Affordable Care Act (ACA) marketplace plans, citing suspected fraud, according to a Sept. 22 announcement by the Trump administration. That number soon could grow.

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Preliminary data for the 2027 Clinical Laboratory Fee Schedule (CLFS) point to substantial downward pressure on Medicare reimbursement for lab services. CMS released information on the 2027 payment rates ahead of final rates expected in November, projecting that the methodology used to set the rates would save $1 billion annually for Medicare. Hospital-based and freestanding labs should prepare for rate decreases of 15% on hundreds of tests.

One out of five adults say they have experienced a denied claim: when an insurance company refuses to pay for the healthcare services they’ve received or a prescription, according to a recent survey.[1] Yet only half of people appeal a denied claim, mostly because they aren’t sure how to do so or who to contact, the same survey found. Meanwhile, 11.65% of all healthcare claims were denied on first pass in 2025.

Erika Grotto talks with Dawn Crump from MRO about audit efficiency. Michael Grant, HFMA’s director of learning experience, discusses updates to HFMA’s learning platform. In the news segment, Nick Hut talks with HFMA policy director Katie Gilfillan about Medicaid eligibility updates. About the Author is a senior editor at HFMA and is based in Downers Grove, Ill.

When a general session fell through during the planning process for the HFMA Western Region Symposium in Las Vegas in January, a Shark Tank-inspired event not only filled the empty slot but also ended up drawing a standing-room-only crowd of nearly 1,000 attendees. Three lesser-known healthcare innovation companies, with solutions that had the potential to transform healthcare revenue cycle and financial operations, were chosen to participate in the Innovation Gauntlet, according to Ramona C.

CMS continues to put weight behind the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, a 10-year initiative to apply value-based payment and digital solutions to chronic disease management. The agency announced Sept. 15 that it would add to the services covered under the model. Newly covered conditions effective April 1, 2027, are set to include heart failure, chronic obstructive pulmonary disease, substance use disorders and tobacco cessation.

AI is gaining ground in the revenue cycle faster than the strategies needed to govern and deploy it, a recent study from UPMC and KLAS Research found. ‘ “Interviewed leaders said the biggest barriers to executing an AI strategy are not a lack of interest or perceived value. Instead, many organizations struggle to create the capacity, structure, and discipline needed to implement AI responsibly,” the report stated.

Value-based care is operating at scale. In 2026, 511 Accountable Care Organizations in the Medicare Shared Savings Program serve approximately 12.6 million people with traditional Medicare, the largest beneficiary population in program history. CMS reports approximately $2.5 billion in net Medicare savings and $4.1 billion in shared savings for the most recently reconciled performance year.

Voters are demanding action to improve healthcare affordability ahead of the midterm elections. The Trump administration sees an aggressive push on state-directed payments (SDPs) as a way to respond to that demand. This year, healthcare affordability and availability were the most important issues to Americans for the first time since 2020, according to Gallup polling. Polls rarely ask whether respondents want policymakers to prioritize healthcare coverage or affordability.