Last week, the Centers for Medicare and Medicaid Services (CMS) finalized the Medicare Physician Fee Schedule for 2025. It includes a 2.9% cut to physician pay.
The fee schedule includes policies aimed at improving access to primary care and boosting reimbursement for behavioral health, but the pay cut instantly drew harsh criticism...National News
On Tuesday, August 20, U.S. District Judge Ada Brown in Dallas struck down the nationwide noncompete ruling by the U.S. Federal Trade Commission (FTC) set to take effect September 4. The U.S. Chamber of Commerce and the Texas-based tax firm Ryan LLC, which brought the lawsuit, warned the rule would retroactively invalidate millions of...
The Center for Healthcare Quality & Payment Reform (CHQPR) offers steps to support its contention that value-based payment is only successful when explicitly designed to support value-based care, which the CMS Innovation Center says requires increased data sharing and the AMA warns is only possible when health systems/plans and...
The 2023 physician survey contradicts health insurance claims that prior authorizations save money. Physicians argue prior authorizations are costly and inefficient, leading to significant expenses for patients, employers, physicians, hospitals, and health systems.
This annual survey by the American Medical Association (AMA)...White Papers, E books, Reports and more
Earlier this year, the American Medical Association (AMA) released the Value-based Care Playbook in partnership with America's Health Insurance Plans (AHIP) and the National Association of Accountable Care Organizations (NAACOS).
The Playbook illustrates best practices for value-based care arrangements in order to encourage adoption...National News
This week, America's Health Insurance Plans (AHIP), the American Medical Association (AMA), and the National Association of ACOs (NAACOS) released a playbook on voluntary best practices as part of their efforts together to advance the adoption of value-based care arrangements in the private sector to improve the quality, equity, and...National News
Last Friday, the Medicare Payment Advisory Committee (MedPAC) sent its recommendations to Congress, including updates for the 2025 Medicare payment systems. In its recommendations, the committee warned that Medicare Advantage policies are increasingly costly to the Medicare program.
At the top, it recommended a 1.5% raise for hospital...National News
The Medicare Payment Advisory Committee (MedPAC) met last Thursday to discuss recommendations for Medicare-related payment rates as Congress and the Centers for Medicare and Medicaid Services (CMS) gear up to address industry reimbursement in 2025.
The committee recommended raises for the hospitals and physicians but wants lower base...
Last Thursday, the Centers for Medicare and Medicaid Services (CMS) finalized the 2024 Medicare Physician Fee Schedule rule, which includes a 3.34% decrease to the schedule's conversion factor, setting it at $32.74, a $1.15 decrease from 2023.
The agency finalized other increases for visits including primary and longitudinal care, and...
As public and political pressure has risen against prior authorization, insurers are scaling back use of the policy and are openly reforming the process.
Back in February, the American Medical Association (AMA) led 118 other medical organizations to write a letter to the Centers for Medicare and Medicaid Services, specifically...
States are employing tech vendors to help facilitate communications for the Medicaid redeterminations process, but they can't curb the high volume of enrollees losing coverage.
More than 90 million Americans must undergo eligibility review over the next several months and the U.S. Department of Health and Human Services has estimated...National News
As the Centers for Medicare & Medicaid Services (CMS) mulls making changes to prior authorization (PA) across several insurance markets, America's largest insurers are automating and speeding up the process by eliminating PA requirements for select hospitals, providers and procedures and by simplifying and automating the PA...CMS Rules
In December, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule that would require all health plans, including Medicare Advantage plans, to limit prior authorization deliberations to seven days. On Monday, the public comment for that rule closed.
Many providers believed that the rule doesn't go far enough,...
Industry stakeholders and patient advocacy organizations are urging Congress to pass legislation that would solidify telehealth waivers passed by the CARES Act during the COVID-19 public health emergency (PHE).
The vast majority of providers see telehealth as an opportunity to improve patient services and 94% of patients who have had...
Last week, the Medicare Payment Advisory Commission (MedPAC) made its recommendations to Congress for Medicare payment rates for hospitals and physicians.
Commissioners made it known that the recommendations were a reflection of the current environment and issues related to the COVID-19 pandemic, but didn't recommend to raise rates...National News
On Tuesday morning, Congressional lawmakers unveiled a titanic omnibus spending bill that includes a 2% cut to Medicare reimbursement rates for doctors, an extension of the telehealth and hospital-at-home waivers, and several other measures that would unwind policies enacted during the COVID-19 public health emergency (PHE) prior to the...National News
Last weel, the Institute for Healthcare Improvement (IHI) announced the formation of the Rise to Health coalition with the American Medical Association (AMA) which intends to bring together healthcare organizations, health systems, and organizations to develop a cohesive approach to health equity in patient care.
Dr. Kedar Mate,...National News
Medical gender transition for America's youth has been a hot-button topic for the better part of the year with a number of limitations and bans placed on gender-affirming care for adolescents and court challenges to insurers who refuse to cover transition procedures.
State-level policymakers across the country, including in Arizona...
Commercial and Medicare Advantage (MA) health insurance markets saw differing concentration trends in 2021.
The 2021 American Medical Association Competition in Health Insurance report found that 75% of the 383 metropolitan statistical area (MSA)-level markets were highly concentrated, up from 73% in 2020 and 71% in 2014. In 91% of...
There will likely be a winter surge of COVID-19 in the next few months, but Americans aren't receiving the bivalent booster shot that targets Omicron variants.
The daily global COVID-19 infection rate is expected to rise by two million daily cases by February, according to an analysis from the University of Washington. Reuters notes...
