Reimbursement News

AMA Announces CPT Code for Moderna COVID-19 Vaccine for Young Kids

by

The American Medical Association (AMA) has updated the Current Procedural Terminology (CPT) code set to include CPT codes for the Moderna COVID-19 vaccine for children aged six months through five...

Hospital Prices 224% Higher for Private Payers than Medicare

by

On average, private payers paid hospitals 224 percent of what Medicare would have paid for the same inpatient and outpatient services, according to a report from the RAND Corporation. Researchers used...

Safety-Net Hospitals Lose $2.2M from 340B Drug Discount Limits

by

Safety-net hospitals have faced around $2.2 million in annualized losses due to pharmaceutical companies limiting 340B drug discounts at community and specialty pharmacies, a report from 340B Health...

CA Doctor Sentenced in Medicare Fraud Scheme Involving Upcoding

by

A California doctor has been sentenced to prison for nearly eight years after his involvement in a $12 million Medicare fraud scheme in which he upcoded and billed Medicare for unnecessary...

AMA Announces CPT Codes for Potential COVID-19 Boosters

by

The American Medical Association (AMA) has updated the Current Procedural Terminology (CPT) code set to include CPT codes for two COVID-19 booster candidates from Pfizer and Sanofi-GlaxoSmithKline...

Hospital Prices Paid by Commercial Health Plans Varied Across US

by

Hospital prices paid by commercial health plans varied between 2012 and 2019, as hospitals with both high and low initial commercial to Medicare price ratios saw increases and decreases over the years,...

HHS Reduced Medicare Appeals Backlog by 88% During FY 2022 Q1

by

HHS ended the first quarter of fiscal year 2022 by reducing nearly 88 percent of the Medicare appeals backlog at the Administrative Law Judge level. According to the Department’s status report...

Professional, Hospital E/M Charge Index Continued to Grow in 2021

by

The median charge index for hospital evaluation and management (E/M) visits increased by 7 percent during the COVID-19 pandemic, according to a white paper from FAIR Health. The FH Medical Price Index...

Psychiatrists See Low Merit-Based Incentive Payment System Scores

by

Psychiatrists had significantly lower performance scores, received more penalties, and earned fewer bonuses in the 2020 Medicare Merit-Based Incentive Payment System (MIPS) compared to other outpatient...

Global Hospital Budget Models May Help Curb Rising Hospital Prices

by

Global hospital budget models with a volume adjustment system could help limit hospital spending growth for commercial payers and patients, according to an issue brief from the Commonwealth...

AHA: Electronic Prior Authorization Implementation Requires Testing

by

The American Hospital Association (AHA) has expressed support for electronic prior authorization processes but urged the Office of the National Coordinator for Health Information Technology (ONC) to...

AMA Urges Congress to Update Medicare Physician Payment System

by

Following a recent Medicare Payment Advisory Commission (MedPAC) report, the American Medical Association (AMA) has asked Congress to update the Medicare physician payment system to include a stable...

Hospitals Saw Substantial Underbilling for Medicare Telestroke Services

by

Following the Furthering Access to Stroke Telemedicine (FAST) Act, Medicare claims for telestroke services increased in rural and urban emergency departments. However, there was still substantial...

AHA Asks CMS to Waive Medicare Advantage Prior Authorization During PHE

by

The American Hospital Association (AHA) has asked CMS to work with Congress and require Medicare Advantage plans to waive prior authorization processes during the current and future public health...

High Hospital Prices Do Not Always Lead to Better Health Outcomes

by

Receiving care from higher-priced hospitals only led to better health outcomes when the facility was in a relatively unconcentrated market. There was no association between high prices and mortality at...

Specialty Pharmacies Offered Lower Drug Prices Than Hospitals

by

Hospitals and physician offices charged patients significantly higher amounts for drugs than specialty pharmacies did, according to a study from AHIP. Rising drug prices have contributed to high...

Cost of Ground Ambulance Services Saw 22% Increase Since 2017

by

The cost of emergency ground ambulance services increased by 22 percent from 2017 to 2020, giving advanced life support ambulance rides a price tag of more than $1,200, according to a white paper from...

Health Plan Automates Prior Authorization Process Using AI

by

Guidewell, the parent company to health plan Florida Blue, has partnered with an artificial intelligence company to automate the prior authorization process. Florida Blue will become the first payer...

Safety-Net Hospitals See Losses from 340B Drug Discount Limits

by

Safety-net hospitals have faced losses of up to $9 million due to a handful of drug companies limiting 340B discounts on prescription drugs dispensed through community pharmacies, according to a report...

Remote Work Propels Electronic Claims Management Adoption

by

Electronic claims management adoption increased in 2020 as healthcare providers shifted to remote work environments when possible, but they are still leaving billions of dollars on the table in...