Insurance

Preventive health services are key to ensuring people seek care before their conditions are critical or urgent in nature. As healthcare services for Medicaid and Medicare beneficiaries expand under the Affordable Care Act, so will the need for professionals who can administer certain preventive measures.

A new analysis from HealthPocket of Medicare drug plans reveals that in both traditional Medicare and Medicare Advantage plans, consumers face various hurdles in accessing their medications.

In an effort to offset cost increases associated with the Affordable Care Act (ACA), the Obama administration intends to expand hospitals' access of the 340B discount drug plan. While the expansion may sound promising to some, many others worry that the program will threaten the quality of care, as increased participation risks higher potential for abuse. Even worse, the 340B program will likely rise the cost of cancer care.

Recovery Audit Contractors (RAC) out to identify improper payments made on claims for Medicare beneficiaries

The Centers for Medicare & Medicaid Services Innovation Center held an Open Door Forum on Aug. 1 to announce some modifications to the application for the Comprehensive ESRD Initiative, or renal-specific Accountable Care Organization demonstration.

Medicare will levy $227 million in fines against hospitals in every state but one for the second round of the government's campaign to reduce the number of patients readmitted within a month, according to federal records released Friday.

On July 8, 2012, the Centers for Medicare & Medicaid Services (CMS) released two major Medicare proposed rules impacting payment for physician and hospital outpatient services in 2014. ASH will submit comments to CMS on the proposed rules by the September 6 deadline and would like to incorporate feedback from the Society's practice-based members.

The Obama administration says the average monthly premium for Medicare prescription drug plans will inch up by $1 next year, to $31.

Washington state won't pay for medical procedures that are unsafe, unproven or cost too much. Why can't Medicare do that?

A Centers for Medicare & Medicaid Services (CMS) proposal would cut providers' reimbursement for dialysis treatment by 9.4%, or approximately $1 billion, nationwide.

Physician groups voiced general support for a bill approved Tuesday by a Congressional subcommittee to replace Medicare's sustainable growth rate (SGR) formula.

Medicare is accelerating plans to peg a portion of doctors' pay to the quality of their care. The changes would affect nearly 500,000 physicians working in groups.

The authors present a brief summary of the types of payment arrangements that early accountable care organizations are adopting.

This segment of the panel discussion takes a closer look at the episode of cost for a patient going to a hospital versus a private office setting. Panelists agree that the cost of hospital care is not that much greater than in the office.

Dr. Chernew asks the panelists how payers address the value of these costly combination therapies when there are less expensive options available. Dr. Newcomer says that the drugs being discussed are, in fact, having a significant clinical effect.

First year results are in - all 32 participants in the Pioneer Accountable Care Organization (ACO) initiative showed success in improving quality. However, not as much success was made in cost savings.

Medicare beneficiaries with diabetes who are at the lowest levels of healthcare consumption often become some of the highest level consumers in subsequent years.

Many physicians who treat Medicare patients may see an end to unreimbursed evaluation-and-management (E&M)

Pharmaceuticals companies continue to weigh options for their role in Accountable Care Organizations (ACOs).

Come 2014, the Centers for Medicare and Medicaid Services (CMS) may push bundling of some outpatient procedures.

A new bill, Cancer Patient Protection Act of 2013 (HR 1416), is aiming to restore Medicare reimbursements for anti-cancer drugs and biologicals to pre-sequester levels

Insurer UnitedHealth Group recently noted it will more than double payments made to physicians who participate in accountable care contacts. ACOs have already demonstrated an immense positive growth in quality care, and a reduction in medical costs.

New recommendations suggest reforming the federal 340b drug discount program. Originally designed to help providers serve the poor or underinsured, misuse has raised concerns for greater transparency in prices and how hospitals are using 340b savings.

While more than 75% of hospitals are participating in the federal electronic health record incentive program, small hospitals and Critical Access hospitals lag behind.

Medicare clients who seek outpatient care may see rise in costs come fiscal year 2014.

The House of Representatives' Energy and Commerce Committee recently released draft legislation that would replace Medicare's current physician payment system with a quality-based system.

Managed care under Medicaid is being called into question, as quality of monitoring varies from state to state.

In January 2012, 32 healthcare organizations became the first to participate in the Medicare Pioneer Accountable Care Organization (ACO) model. Now, over a year into the initiative, as many as 9 organizations are in deliberation of leaving the program.