Health Plan Automates Prior Authorization Process Using AI
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
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
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...States with More Uninsured Received Greater COVID-19 Treatment Funding
An analysis published in JAMA Health Forum linked uninsured population size to federal reimbursement for uninsured COVID-19 treatment. The Health Resources and Services...AMA Updates CPT Codes for Pediatric COVID-19 Vaccine
The American Medical Association (AMA) has updated the Current Procedural Terminology (CPT) code set to include a new code for administering pediatric doses of Pfizer’s COVID-19 vaccine...AMA Challenges MedPAC Suggestion to Freeze Medicare Physician Payment
The American Medical Association (AMA) published a statement criticizing the Medicare Payment Advisory Commission’s (MedPAC’s) stance on Medicare physician payments next...Sponsored by Zelis
Key Ways to Improve Access to Claims Data for a Smoother Revenue Cycle
Healthcare claims contain a wealth of information. Each service line on a claim paints a picture of a patient’s healthcare journey, including their quality of care as well as the cost of that...More Pharma Companies Limit 340B Discounts to Safety-Net Hospitals
Bristol Myers Squibb has notified safety-net hospitals participating in the 340B Drug Discount Program that it will only recognize two designated contract pharmacy locations per hospitals. The company...MedPAC Recommends Hospital Reimbursement Increase
The Medicare Payment Advisory Committee (MedPAC) has voted to recommend increases to hospital reimbursement for both inpatient and outpatient services in fiscal year (FY) 2023. MedPAC convened...Sponsored by Zelis
Electronic Payment Key to Streamlining Healthcare Claims Management
The complexity around healthcare claims management is a major pain point for provider organizations, big and small. The increasing cost of claims coupled with a complex system of many payers, each with...CPT Code for Third Dose of Pediatric COVID-19 Vaccine Added
The American Medical Association (AMA) announced a Current Procedural Terminology (CPT) code set update to include a code for administering a third dose of Pfizer’s COVID-19 vaccine in...Patient-Driven Payment Linked to a Decrease in SNF Therapy Utilization
The implementation of the Patient-Driven Payment Model (PDPM) was associated with a decrease in the volume of rehabilitation therapy utilization, according to a study published in JAMA...R1 RCM to Acquire Cloud-Based Healthcare Revenue Company Cloudmed
R1 RCM Inc. has announced that it will acquire the cloud-based healthcare revenue intelligence company Cloudmed in an all-stocks transaction expected to close in the second quarter of 2022. Cloudmed...Sponsored by Zelis
