Reimbursement News

States with More Uninsured Received Greater COVID-19 Treatment Funding

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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

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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

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The American Medical Association (AMA) published a statement criticizing the Medicare Payment Advisory Commission’s (MedPAC’s) stance on Medicare physician payments next...

More Pharma Companies Limit 340B Discounts to Safety-Net Hospitals

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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

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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...

CPT Code for Third Dose of Pediatric COVID-19 Vaccine Added

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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

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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

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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...

COVID-19 Tests Spike Growth in Medicare Spending

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COVID-19 tests spiked growth in Medicare spending in 2020. Meanwhile, spending for non-COVID-19 lab tests experienced a decline, according to a report from the HHS Office of the Inspector...

Hospital Prices for Most Services Less than Payer-Negotiated Rates

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According to a JAMA Network Open study, discounted cash prices for hospital services often cost less than negotiated commercial prices between hospitals and payers. However, not all hospital...

In-Network, Complex COVID-19 Hospitalizations Cost More Than $128K

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According to a new FAIR Health study, COVID-19 hospitalization cost varies by state, with complex hospitalizations for COVID-19 in-network average cost maxing out at $128,650.  “Behind the...

American Renal, Former Execs Charged with Healthcare Fraud Scheme

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The Securities and Exchange Commission (SEC) has charged the nationwide dialysis service provider American Renal Associates Holdings of engaging in a healthcare fraud scheme involving revenue...

Legislation Stopping Medicare Payment Cuts Clears Congress

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UPDATE 12/10/2021: In a 59 to 35 vote on Thursday, the Senate passed legislation that will prevent statutory Medicare payment cuts from taking effect next year. The bill cleared the House earlier this...

AMA, AHA Sue Feds Over No Surprises Act Final Rule

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The nation’s leading hospital and physician groups have filed a lawsuit against the federal government over final rules implementing the independent dispute resolution (IDR) process detailed in...

House Dems Look to Prevent Medicare Payment Cuts

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UPDATE 12/08/2021: A deal has been reached to avert some of the pending Medicare payment cuts. Congressman Steven Horsford (D-NV) and Congresswoman Kim Schrier (D-WA) introduced the...

COVID-19 Associated with $13.9B Decline in Medicare Spending

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According to a new American Medical Association (AMA) report, utilization of physician services in 2020 declined due to the COVID-19 pandemic, creating a less than expected decline of $13.9 billion in...

Providers Accuse NC Payer of Abusing No Surprises Act, Cutting Rates

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The American Society of Anesthesiologists (ASA) recently accused BlueCross BlueShield of North Carolina of abusing the No Surprises Act to manipulate the market by pressuring clinicians into lower...