Policy and Regulation

CMS Develops New Billing Codes for Coronavirus Lab Tests

by Jacqueline LaPointe

CMS recently announced the development of new billing codes for coronavirus lab tests that will enable clinical laboratories and other providers to receive reimbursement for supporting patients during...

Community Health Centers to Get Funding for Coronavirus Outbreak

by Jacqueline LaPointe

UPDATE 03/06/2020: HR 6074 became public law no: 116-123 on March 6, 2020. The federal government is one step closer to delivering funds to key stakeholders in the novel coronavirus...

FDA Allows Coronavirus Diagnostic Testing in Certain Hospital Labs

by Jacqueline LaPointe

In order to achieve more rapid coronavirus diagnostic testing capacity, the FDA will allow certain clinical laboratories, including some hospital labs, to use diagnostic kits developed in-house to test...

More States Passing Laws to Preserve Provider Competition

by Jacqueline LaPointe

All states have anti-trust statutes in place to preserve provider competition in the face of rapid consolidation, but more state governments are relying on price transparency, health plan contracting...

CMS Seeks Extension for Comprehensive Care for Joint Replacement

by Jacqueline LaPointe

The Comprehensive Care for Joint Replacement (CJR) Model is slated to sunset by the end of the year, but a recently proposed rule from CMS would extend the bundled payment program for another three...

Claims Reimbursement Changes Notably Reduce Low-Value Care

by Samantha McGrail

A greater reduction in low-value vitamin D screening was associated with a claims reimbursement change related to recommendations, according to a recent study. Published in JAMA Network Open on...

HHS Defends Hospital Price Transparency Rule to Judge

by Jacqueline LaPointe

Patients should be able to know the prices of services before they receive care, HHS stated in response to a lawsuit challenging the department’s most recent hospital price transparency...

Hospital Price Transparency Services Scratch Surface of Spending

by Jacqueline LaPointe

A recent analysis conducted by the Health Care Cost Institute (HCCI) is raising questions about the efficacy of a consumer-centered hospital price transparency requirement slated to take effect next...

American College of Physicians Endorses Single-Payer System

by Jacqueline LaPointe

The second-largest physician group in the US recently recommended the implementation of a single-payer system or public option to achieve universal coverage. According to a policy plan released on...

GAO Calls for More Oversight of 340B Drug Pricing Program

by Samantha McGrail

Weaknesses in HRSA oversight of the 340B drug pricing program may result in some hospitals receiving discounts when they are not eligible to participate, a new report from The Government Accountability...

AHA, AAMC Sue HHS Again Over Outpatient Site-Neutral Payments

by Jacqueline LaPointe

Hospital stakeholders filed a lawsuit on Monday challenging HHS’ most recent attempt to implement site-neutral payments for certain outpatient services rendered in hospital settings. Contending...

Former Anthem Exec to Lead CMMI, Value-Based Care Efforts at HHS

by Jacqueline LaPointe

The Trump administration announced on Monday that it has picked Brad Smith to serve as director of the CMS Innovation Center (CMMI), where he will oversee the development and testing of value-based...

Medical Groups Worry About Risk in Anti-Kickback, Stark Law Reform

by Samantha McGrail

Tying Anti-Kickback and Stark Law reform to the level of financial risk providers assume creates more complexity and burden and could impede the transition to value-based care for physicians, advocacy...

Providers to Focus on Patient Billing, Policy Heading into 2020

by Jacqueline LaPointe

Patient billing, policy and regulation, healthcare mergers and acquisitions, and workforce diversity will be some of the top priorities for provider organizations in 2020, predicted researchers at...

New Healthcare Price Transparency Rule to Unveil Negotiated Rates

by Jacqueline LaPointe

HHS dropped two healthcare price transparency rules earlier today. The first is a final rule requiring hospitals to make all standard charges, including payer-specific negotiated rates, public in a...

MedPAC Suggests Elimination of Incident To Billing for APRNs, PAs

by Jacqueline LaPointe

CMS should do away with “incident to” billing for advanced practice registered nurses (APRNs) and physician assistants (PAs) and pursue a stay-based payment design when implementing a...

Verma: Healthcare Payment Reform to Focus on Docs, Not Hospitals

by Jacqueline LaPointe

Focusing healthcare payment reforms efforts on providers, rather than hospitals, will be key to lowering healthcare costs, CMS Administrator Seema Verma recently told stakeholders. “Over the...