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Reimbursement

A photo of Jerome Adams, MD, MPH

I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

Everyone must be able to access necessary care without fear of financial ruin

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Fraudulent Practices Abound in Post-Accident Healthcare

These costs often fall unfairly on patients and insurance providers

A screenshot of Sheldon Whitehouse speaking during this hearing.

Pre-Approval Plan Proposed for Medicare Advantage Insurers

"No prior authorization without prior authorization," Senate Budget Committee chair says

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Medicare Hospital Trust Fund to Stay Solvent Until 2036, Trustees' Report Says

Projection is 5 years longer than last year's prediction

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Fed Up With Prior Auths? What if Insurers Had to Pay You for Submitting Them?

NYC urologist is seeking approval for a prior authorization CPT code

A photo of a mature male physician looking out the window of a hospital lobby.

The Plight of the Late-Boomer Physician

Does anyone besides me feel like we got the short end of the financial stick?

A screenshot of UnitedHealth CEO Andrew Witty speaking during this hearing.

UnitedHealth CEO Slammed at Senate Hearing on Change Healthcare Cyberattack

"A comprehensive scrub" of company's anti-competitive practices is long overdue, senator says

A screenshot of Daniel Tsai speaking during this hearing.

House Republicans Bash New Nursing Home and Home Care Rules at Hearing

"This approach simply won't work," said chair of the House Energy & Commerce Health Subcommittee

A photo of Adam Bruggeman, MD speaking during this hearing.

Lawmakers Take Up Fallout From Change Healthcare Cyberattack

Health sector likely to remain an "attractive target," says congressman

A screenshot of Frank Pallone speaking during this hearing.

Improper Payments in Medicare and Medicaid: Who's at Fault?

Republicans and Democrats took differing approaches on the subject at a House hearing

Federal Probes Need to Look Beyond Private Equity-Owned Healthcare for Alleged Abuse

Non-profit entities should also be fair game, says Ron Harman King, JD, MS

A screenshot of Lee Schwamm, MD, speaking during this hearing.

House Members Struggle to Craft Road Map for Future of Telehealth

Lawmakers examine issues around reimbursement, licensure, and patient choice

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Biden Administration Cracks Down on 'Junk' Health Insurance Plans

Under final rule, insurers will have to spell out what these policies do not include

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Medicare Debuts Another Primary Care-Focused Accountable Care Model

Primary Care Flex will pay ACOs a monthly fee to be given to primary care practices

A photo of a box of Wegovy injection pens.

Medicare to Cover Weight-Loss Drug Wegovy for Certain Patients

News comes in the wake of FDA approval to reduce risk of heart attacks, stroke

A photo of optometrist Hunter Morgan in his office

California Wants to Pay Doctors More Money to See Medicaid Patients

How much and who will get it will be determined later this year

A photo of a senior patient using a walker in the hallway of a nursing home.

MedPAC's Report Recommends Pay Changes for Healthcare Services

Report highlights MA quality, overpayment issues, and urges action on four prior recommendations

How Can the U.S. Prevent Future Cyberattacks Like the One on Change Healthcare?

To start with, more "outside in" testing is needed, expert says

A screenshot of Ateev Mehrotra, MD, MPH, speaking during this hearing.

Lawmakers Quibble Over Whether Telehealth Should Be Cheaper Than In-Person Visits

Lawmakers, witnesses disagree on the answer at a House hearing on home healthcare

A photo of the interior of an Aledade office.

Largest Independent Primary Care Network in the U.S. Accused of Medicare Fraud

Whistleblower lawsuit alleges Aledade encouraged doctors to tack on suspect medical diagnoses

A photo of ambulances outside of a hospital in Montgomery, Alabama.

MedPAC Members Pan Rural Hospitals' 'Cost-Plus' Billing System for Medicare Patients

Allowing the system to stay in place is "unconscionable," says one commissioner

A photo of Christopher Koller speaking during this hearing

Medicare a Big Contributor to the Broken Health Payment System, Senators Told

Use of "hybrid" payment model urged

A photo of the US Capitol building.

Most Doc Groups Unhappy With Proposed Congressional Budget Deal

Measure would restore some, but not all, of the cuts to the Medicare Physician Fee Schedule

A photo of a mature male physician standing in a hospital hallway holding a clipboard and talking on the phone

Can Artificial Intelligence Improve Prior Authorization?

Possibly, but "complete transparency" about its use would be needed, expert says

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There's Still Time to Switch Medicare Advantage Plans This Year

Beneficiaries have until March 31 to find a new plan; doctors should check plans, too

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States Target Health Insurers' Red Tape Around Prior Authorization

Pending bills in multiple states include policies backed by the AMA

AAOS over a photo of Moscone Center in San Francisco, CA

Orthopedic Surgeons on Track to Earn Less Than Taco Bell Workers

If current trends continue, patients are in big trouble

A photo of Rep. Larry Bucshon (R-Ind.) speaking at this event

Not Passing a Bill to Fix Medicare Doc Pay Cuts Is 'Appalling,' Lawmaker Says

Rep. Larry Bucshon, MD, also talks about prior authorization, violence against health workers

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MedPod Today: Medicare Advantage Woes, Double Billing, NHPI Health Disparities

名媛直播 reporters offer further insights on these recently covered topics

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Medicare Sends Initial Price Negotiation Bids to Drugmakers

Manufacturers of 10 drugs have 30 days to accept or make a counter-offer

CMS Focusing on Better Aligning Quality Measures, Adding New ACO Models

Clinicians shouldn't have to navigate hundreds of different measures, Medicare director says

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Value-Based Care: Filling Critical Gaps in Care and Clinician Leadership

One Chicago health plan has come up with a unique program for doctors just starting out

A photo of a senior woman looking up her medications in a health insurance brochure.

Will All Seniors Eventually Have No Choice but Medicare Advantage?

MedPAC chair discusses need to fix MA's confusing limitations, upcoding, and rising costs

A close up photo of an IV catheter and tubing

Infusion Drug Mark-Ups Higher at Safety Net Hospitals

Study shows big difference in reimbursement-to-acquisition cost ratio versus private practice

A photo of a female physician holding a mammogram and filling out a form.

Is Adding an AI Readout to Mammography Worth It?

Women would have to pay out-of-pocket, as reimbursement is a long way off

A photo of Rep. Suzan DelBene (D-Wash.)

Q&A: Talking Prior Authorization With Rep. Suzan DelBene

The Washington congresswoman also discusses home dialysis, Medicare cuts

A photo of a male physician talking on the phone and holding a tablet.

CMS Issues Final Rule on Prior Authorizations

The rule, which doesn't apply to commercial insurers, sets time limits on responses

A photo of a tired looking female physician leaning against a window.

Is Burnout Destroying Emergency Medicine?

It doesn't have to: here are four unique ways to address the issue

A photo of a woman putting three $100 bills into the pocket of a senior male physician.

Docs Need Inflation-Adjusted Medicare Pay Increase in 2025, MedPAC Members Say

Draft recommendation also calls for added pay to take care of low-income beneficiaries

A photo of Rep. Greg Murphy, MD (R-N.C.)

Medicare Doc Payment Fix Bill Moving Along, GOP Doctors Caucus Co-Chair Says

Rep. Greg Murphy, MD, is hoping for action within a week

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