Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Prescription Drug Rates

Hospitals to See 7.61% Rise in 2018 Prescription Drug Rates

by Jacqueline LaPointe

Hospitals and health systems should anticipate a 7.61 percent increase in prescription drug rates in 2018, researchers predicted in a recent Vizient study. Using the group purchasing organization’s 2016 and 2017 data on hospital and...

Hospital Orgs Oppose Site-Neutral Medicare Reimbursement Cuts

by Jacqueline LaPointe

Several hospital groups recently spoke out against proposed 2018 Medicare reimbursement updates that would reduce site-neutral payments to off-campus provider-based departments from 50 percent of the outpatient rate to 25 percent. CMS...

Hospitals, ASCs, 340B Drugs Face Medicare Reimbursement Changes

by Jacqueline LaPointe

CMS recently proposed a rule that would update Medicare reimbursement rates for hospitals and ambulatory surgical centers as well as change some prescription drug rates to 340B hospitals. Hospitals would see a 2 percent Medicare...

Provider Profitability Drops Under Biosimilar Use Reimbursement

by Jacqueline LaPointe

Biosimilar use could be the key to lowering healthcare costs associated with biologic treatments, but provider profitability may suffer by as much as $100 million across care settings if providers continue to administer the low-cost...

96% of Healthcare Execs Report Rise in Inpatient Drug Spending

by Jacqueline LaPointe

Approximately 64 percent of healthcare executives reported that inpatient drug spending at their organization significantly increased over the past five years, a recent Premier Inc survey revealed. Another 32 percent said that it...

Will Behavioral Economics Improve Alternative Payment Models?

by Jacqueline LaPointe

Alternative payment models may need to account for the behavioral economics behind provider prescribing habits to effectively reduce healthcare costs from expensive medications and treatments, a recent American Journal of Managed Care...

Prescription Drug Rates Remain Top Healthcare Supply Chain Issue

by Jacqueline LaPointe

Almost all health system executives (99 percent) in a recent Premier survey agreed that rising prescription drug rates continue to plague their healthcare supply chain. The winter 2017 survey of 91 C-suite executives at health systems...

Medicare Spending on Drug Coverage Tripled from 2010 to 2015

by Jacqueline LaPointe

Medicare spending on prescription drugs under the Part D catastrophic coverage program more than tripled from 2010 to 2015, increasing from $10.8 billion to $33.2 billion, the Office of the Inspector General (OIG) recently reported. The...

Drug Costs, Limited Claims Reimbursement Challenge Cancer Care

by Jacqueline LaPointe

Cancer care centers named high prescription drug costs and lack of claims reimbursement for supportive services as the top challenges associated with providing care in 2016, according to an annual Association of Cancer Care Centers (ACCC)...

HRSA Adds $5K Fines for 340B Prescription Drug Rate Overcharging

by Jacqueline LaPointe

Drug manufacturers participating in the 340B Drug Pricing Program who intentionally charge hospitals prescription drug rates higher than established ceiling prices will face a $5,000 penalty per instance, a new Health Resources and...

AMA Backs Team-Based Care Delivery, Value-Based Drug Pricing

by Jacqueline LaPointe

The American Medical Association (AMA) recently released updated organization-wide ethical guidelines that detailed how organizations can lower healthcare costs using team-based care delivery as well as how the industry can implement...

AHA Calls for Hospital Access to Prescription Drug Rate Info

by Jacqueline LaPointe

The American Hospital Association (AHA) recently urged the Health Resources and Services Administration (HRSA) to grant hospitals in the 340B Drug Pricing Program more access to prescription drug rate information. In a comment letter on a...

Hospitals Saw 23% Rise in Inpatient Prescription Drug Spending

by Jacqueline LaPointe

Hospital inpatient prescription drug spending has increased by 23.4 percent from 2013 to 2015, reported a recent study from the University of Chicago’s NORC. The increases in spending have left most providers struggling to manage...

GAO: Drug Couponing Affecting Medicare Reimbursement Rates

by Jacqueline LaPointe

The methodology for calculating Medicare reimbursement to providers for prescription drugs under the Part B program may be contributing to higher Medicare spending because it does not account for the impact of coupon programs, according to...

Pharma Payments Influence Prescription Drug Spending

by Jacqueline LaPointe

Payments from pharmaceutical manufacturers may be more influential on physician prescribing habits than concerns over the rise in prescription drug spending, according to a recent study in the BMJ. Researchers found that small payments...

$17B Increase in Medicare Part D Prescription Drug Spending

by Jacqueline LaPointe

Prescription drug spending under the Medicare Part D program increased by $17 billion between 2013 and 2014, representing a 17-percent increase, according to new CMS data. While the federal reported a significant boost in prescription...

Would Proposed Value-Based Reimbursements Reduce Drug Costs?

by Jacqueline LaPointe

Spending on prescription drugs has been a major pain point for all stakeholders in the industry. But could value-based reimbursement models for certain drugs under Medicare Part B be the answer to rising drug costs? According to a Health...

$2.75B in Unexpected Healthcare Spending Impacts VA Budget

by Jacqueline LaPointe

The Department of Veteran’s Affairs (VA) has encountered $2.75 billion in unanticipated healthcare spending  during the 2015 fiscal year due to an increase in community care program participation and new hepatitis C drugs,...

Cancer Costs Don’t Rise Faster than Other Healthcare Spending

by Jacqueline LaPointe

Cancer-related healthcare costs have increased at almost the same rate as non-cancer healthcare spending since 2004, according to a recent study by Milliman and the Community Oncology Alliance. The study counteracts the common misbelief...

Affordable Care Act Saved Medicare Beneficiaries $20 Billion

by Jacqueline DiChiara

The Affordable Care Act (ACA) has saved over 10 million Medicare beneficiaries upwards of $20 billion on prescription drugs over the past six years, according to new information from the Centers for Medicare & Medicaid Services...

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