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Reimbursement

CMS issued a proposed payment rule late on Thanksgiving Eve.
Nov 28 | Susan Morse
States, as Georgia has done, could waive certain ACA requirements to develop their own state healthcare programs.
Person with stethoscope consults person in a hospital bed
Nov 24 | Mallory Hackett
Risk adjustment data validation ensures payment integrity and accuracy - and it affects what plans are paid.
Person wearing stethoscope handles papers and a calculator
Nov 24 | Susan Morse
Barring an appeals court decision overturning the rule, the mandate goes into effect on January 1, 2021.
A person in scrubs examines a prescription pill bottle that another holds up
Nov 24 | Susan Morse
PhRMA questions the cost savings and says the rule leaves safety considerations to state governments, rather than the…
The AHA is against the Most Favored Nation Model as hospitals would lose drug reimbursement.
Nov 23 | Susan Morse
The interim rule would cut drug reimbursements to hospitals by an average of 65% when fully phased in,…
CMS changed Stark Law regulations on Friday.
Nov 21 | Susan Morse
The old federal regulations burdened providers with added administrative costs and fear of financial consequences, CMS…
On Friday, HHS issued a final rule ending PBM rebates to insurers.
Nov 21 | Susan Morse
Opponents say the rule will not lower drug prices, and some question whether it is legal, having bypassed the…
The letter warns that the new thresholds are too high and will force many clinicians to exit from APMs and revert back to fee-for-service.
Nov 20 | Mallory Hackett
The letter warns that the new thresholds are too high and will force many clinicians to exit from…
Person in medical jacket consults with person in hospital bed
Nov 19 | Jeff Lagasse
Automating risk stratification kept patients out of the ER, giving financial incentive to move to an…
Geisinger Medical Center in Danville, Pennsylvania
Nov 19 |
Earlier this year, the Pennsylvania health system implemented eICU support for more than 60 rooms within a week.

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