Where healthcare challenges find solutions
CMMI unveils ESRD payment model to improve health equity
CMS' 2022 end-stage renal disease prospective payment system proposal also updates payment rates and delays quality reporting for dialysis providers.
Investors are banking on primary care providers moving to value-based care
The company is aimed at helping primary-care clinics, independent pharmacies and urgent care centers transform from fee-for-service to value-based contracts with private insurers and Medicare.
Streamlined payer-provider contracting could cut administrative costs by 63%, study finds
Using templated contract structures, digitizing records and limiting prior authorization could help reduce billing and insurance related costs by between 27% and 63%.
Hospitals decry extending Medicare cuts to pay for infrastructure bill
The American Hospital Association and other hospital groups are urging the Senate to abandon a plan to pay for a bipartisan infrastructure bill with cuts to Medicare providers.
Organ payment changes include patient risks, hospitals warn
CMS wants to stop paying for organs that go to people Medicare doesn't cover. But hospitals claim the changes are impossible to put into practice and could make it hard for people to get necessary transplants.
High costs, high deductibles inspire cash pay
The rise of high-deductible health plans and a lack of transparency in drug pricing is driving patients to pay for generics out-of-pocket.
UnitedHealthcare delays new ED claims denial policy
UnitedHealthcare received significant backlash for the policy that would retroactively deny payment for patients seeking non-emergent care in emergency departments.
Colorado, national business groups plan to negotiate directly with hospitals
Local employers are joining two purchasing groups to launch a regional network of excellence, with the aim of negotiating directly with health systems to set prices for common procedures.
United unveils policy to retroactively deny patient ED claims
A controversial new UnitedHealthcare policy intended to tamp down on emergency department visits and costs has drawn ire from providers, while insurance analysts question what, if any, impact the regulation will have.
CMMI exploring more mandatory models, Fowler says
CMS' Center for Medicare and Innovation could mandate more participation in future models and design its experiments to allow more communities to participate in them.
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