The California-based health system will pay a hefty price to resolve allegations that it knowingly submitted inflated diagnosis codes for certain Medicare Advantage beneficiaries to receive higher payments. Sutter Health does not admit any liability in the matter.
In the U.S., where now at least 70% of adults have been vaccinated against the virus, Covid-19 is putting the pathway to true healthcare reform in sight. The needed reform has to be built with three elements in mind.
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.
Sustaining the momentum that telehealth has due to Covid starts with a commitment to building positive incentive structures that will redound to the benefit of patients, providers, and payers alike.
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.
The hospitals are pushing HHS to recognize patients eligible for Medicaid under the ACA as "low-income" when calculating Medicare disproportionate share hospital payments in states that did not expand Medicaid. The agency's refusal to do so resulted in the hospitals receiving lower reimbursements for three years, the lawsuit claims.
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.
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.
Only with proper coverage and access to the modern technologies that made their mark during Covid-19 can we truly democratize healthcare and make the promise of digital health available to all.
A group of hospitals have sued HHS Secretary Alex Azar, arguing he should reverse a policy that prevents hospitals from getting reimbursed for Medicare-related bad debts pending at outside collection agencies. The policy has raised hospital debt payments by about $1.35 million, the lawsuit claims.
SoftBank’s second Vision Fund led the recent funding round. Pear plans to use it to accelerate reimbursement coverage for its three FDA-cleared products.
While there are encouraging signs of reimbursement falling in step with the move towards a more value-based healthcare system, what is needed now to further encourage healthcare innovators is to properly rationalize approval processes imposed by the FDA and CMS.
We will highlight Build My Health's revenue practice management tools, which could help physician practices add up to $250,000 to their practices.
Chance Scott, a Director in life sciences at Guidehouse, talks about some of the challenges digital health innovators face, from reimbursement by private plans to the future of reimbursement for other telehealth tools and digital therapeutics.
The CEO of the telehealth company that just went public said reimbursement has improved, but not to the point where it is interchangeable with in-person care. But he still has high hopes for the future as he sees more physicians turning to telehealth.
Attaining reimbursement often has the greatest impact on patient access and can progress a new treatment toward widespread adoption.
Four experts with the VA, Providence St. Joseph Health, Microsoft and One Medical shared what is needed for continued adoption of telehealth. Most pointed to better integration with clinical workflows and new payment models as future drivers for growth.
During a Monday hearing, the Senate Committee on Health, Education, Labor and Pensions discussed which changes to telehealth coverage made during the Covid-19 pandemic should stay.