reimbursement
publication date
Post-Acute
Data Reflects LTC Staffing Woes, Post-Pandemic Struggles
Nursing home staffing levels have not been so low since 1994.
Pharma
Senate Presses CMS for Updates on Pharma Price-Gouging Penalties
The IRA provisions took effect for Medicare Part B drugs on October 1, 2022, and for Part D drugs on...
Technology
CMS Improves Medicaid Reimbursement for Digital Health Consults
The Centers for Medicare & Medicaid Services has issued guidance changing Medicaid and CHIP coverage for eConsults, or provider-to-provider specialty...
Revenue Cycle
Is Prior Auth Automation the Key to Improved Financial Performance?
Prior authorizations are a critical part of the revenue cycle as they impact both reimbursement and patient access to care,...
Revenue Cycle
Rev Cycle Leaders Are Still Eyeing COVID-19 Reporting
2022 brought many challenges for revenue cycle leaders, and COVID-19 reporting was no exception.
Revenue Cycle
Payment Rate Increases for 2023 No Help to Hospitals' 'Tremendous Financial Pressures'
CMS released the 2023 OPPS final rule that includes increased Medicare reimbursement and the establishment of a new provider type,...
Revenue Cycle
Revenue Integrity Industry Report Highlights Trends and Opportunities for Rev Cycle
As hospitals face more financial troubles and turn the focus toward ROI, many revenue cycle leaders have been developing revenue...
Revenue Cycle
The Useful 5: Regulatory Roundup for Rev Cycle Leaders
HealthLeaders' regulatory round up series highlights five essential governing updates that cover every aspect of the revenue cycle that leaders...
Pharma
35 AGs Back OK's Authority to Regulate PBMs
The PBM lobby has called the states' push for oversight "both misplaced and irrelevant."
Payer
HHS-OIG says Humana's MA Plan Overcharged $34.4M
HumanaChoice says it 'strongly disagreed' with the audit, which found that 76% of claims 'were not supported in the medical...
Revenue Cycle
Clawback: Feds say NYC Improperly Billed Medicaid for $84.3M
OIG auditors were unable to determine if an additional $112 million in non-emergency medical transportation claims complied with state and...
Payer
AMA, State Medical Societies Join Class Action Lawsuit Against Cigna
The groups allege the health insurer underpaid claims submitted by patients for services covered through MultiPlan.