Why it’s time for hospitals to modernize their payment systems
By improving billing and payment systems, healthcare providers can help ease what is a common, anxiety-inducing burden for many patients.
Take a holistic approach to genomic testing reimbursement
To get to the root of existing reimbursement problems, health plans should consider tackling genomic benefits management in a way that addresses test ordering and billing challenges.
With the Rise of AI, What IP Disputes in Healthcare Are Likely to Emerge?
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
Blue Shield of California, Google Cloud to develop real-time claims processing platform
The companies will build their claims processing platform on Google Cloud's infrastructure, leveraging artificial intelligence and machine learning capabilities. The goal of the collaboration is to improve patient and provider experience and reduce spending on administrative processes.
Feds provide payment resolution process in new surprise billing rule
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.
Remote patient monitoring use is on the rise, but reimbursement needs to catch up
The reimbursement model for remote patient monitoring needs to evolve as it may be holding providers back from investing in these programs, according to panelists at the MedCity INVEST Digital Health conference. Key issues with the structure as it stands now include the fact that there are too many gray areas that result in claims denials.
CMS offers additional Medicare payments for at-home Covid-19 vaccinations
Now, Covid-19 vaccine administrators can earn an additional $35 per vaccination for up to five Medicare beneficiaries who live in a communal living space, like smaller group homes or assisted living facilities. CMS aims to boost vaccination rates with this pay increase.
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A Personalized Approach to Medication Nonadherence
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
Transforming rural healthcare will require a funding overhaul. Here’s one way to do it.
The answer to rural healthcare's financial issues could lie in a payment model that pools funds from public and private insurers alike to pay for agreed-upon core services, allowing rural hospitals to provide the care most needed by the communities they serve.
Survey: Most health organizations hit by ransomware had their data encrypted
A third of healthcare organizations reported being victims of a ransomware attack in 2020, according to the results of a global survey. Of these, a majority (65%) said their data was encrypted by cybercriminals in the most significant attack they faced.
CMS ups Medicare payment for at-home vaccinations to about $75 per dose
CMS is increasing the payment for administering at-home Covid-19 vaccinations from around $40 to $75 per dose. The move comes amid the Biden administration's push to boost vaccinations nationwide, including among older adults who may not be able to access vaccine sites.
CMS’ Next Generation ACO Model to end this year
In a move that ACOs found "disappointing," CMS has declined to extend the Next Generation ACO Model beyond 2021. Though evaluations have found that the model did not generate net savings for Medicare, proponents argue that the program was successful.
Maximize Revenue and Patient Care with Strategic Weight Loss Management
We will highlight Build My Health's revenue practice management tools, which could help physician practices add up to $250,000 to their practices.
Providers to HHS: ACO quality reporting changes create undue burdens
Eleven provider organizations sent a letter to HHS urging them to reconsider the new rules around quality measurement and reporting for ACOs. One of the reasons these rules are burdensome and should be revised is the lack of EHR interoperability, they said.
CMS proposes putting $2.5B into hospitals’ coffers, eliminating part of price transparency rule
CMS has released its proposed inpatient payment rule for fiscal year 2022, which includes a payment bump that could increase reimbursement for hospitals by $2.5 billion. Further, in a win for hospitals, the proposal aims to repeal a part of the price transparency rule related to Medicare Advantage plans.
Stanford Health Care seeks up to $1.9M from Anthem in new suit
The California-based provider has filed a lawsuit against the payer, claiming Anthem has yet to pay for the care it provided to patients covered by its affiliate. Stanford and Anthem had an implied contract, and if it is not upheld by the court, the provider is seeking $1.9 million in reimbursement.
Medicare payment for Covid-19 vaccines jumps to $40-$80
CMS has increased the Medicare payment rate by $12 for administering single-dose Covid-19 vaccines and by $35 for two-dose vaccines. The payment increase aims to support providers as they ramp up vaccine administration.
Intermountain, UnitedHealthcare create ACO for Medicare Advantage members
The health system and payer will coordinate care for eligible Medicare Advantage patients through the ACO, with the aim of improving health outcomes and reducing costs. The ACO expands a long-standing relationship between the two entities.