Where healthcare challenges find solutions
Providers push for Medicare pay boost
CMS should reconsider budget neutrality and the associated pay cuts, the American Medical Association recommended. »
Payer investment in virtual substance abuse treatment grows
By adding companies like Ria Health in-network, payers are looking to cut members' costly emergency department visits through chronic condition management.
Biden to toss Medicare coverage for "breakthrough" technology
The Biden administration plans to withdraw a Trump-era rule over patient safety concerns, but it could issue a new one down the line.
Vermont's Medicare program reduced hospital stays, saved money
The report commissioned by the Centers for Medicare and Medicaid Services and released this week looked at the first two years of Medicare participation in Vermont in what is known as the all-payer model of healthcare.
UnitedHealthcare pays providers below standard rates for COVID-19 vaccines
Doctors worry that low fees for administering COVID-19 vaccinations could extend and exacerbate the public health crisis.
Home health agencies threaten lawsuits if CMS tries to claw back money
Providers aren't happy with how CMS evaluated home health payment changes, teeing up a potential lawsuit if regulators try to claw back money.
For member health and specialty drug spend, an integrated PBM is the clear choice
Treating complex conditions is costly. An integrated PBM, like CVS Caremark, can help payors manage specialty spend using data analytics while maintaining clinical rigor. Vendors who promise savings by “carving out” specialty benefits not only fail to deliver, but may jeopardize patient safety.
Payers, patient advocates warn against overuse of arbitration in surprise billing disputes
Payers and providers are once again divided on how to proceed on surprise billing regulations.
It's time to get ready for the surprise billing ban, experts say
The Biden administration hasn't released essential details about how the No Surprises Act will work. But providers need to start preparing for the new rules now—and most aren't ready.
New Medicare hospitals get paid 3 times more for capital costs than older facilities, watchdog finds
Special payments to new hospitals cost taxpayers a bundle—and they might be unnecessary, HHS' Office of Inspector General found.
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