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Hospitals Lose Reimbursement for 'Unnecessary' ER Visits
Designed to curb the "overuse and abuse" of costly emergency care, Washington's hospitals will no longer receive Medicaid reimbursement for any "unnecessary" emergency room visits starting April 1, reported The Seattle Times.
In what could be the nation's most restrictive Medicaid ER policy, the program would stop payment for roughly 500 conditions, ranging from the obviously nonemergent diaper rash to the more complicated hypoglycemic coma and chest pain, the article noted.
Emergency physicians and hospitals would be left to foot the bill for treating those conditions.
Read the full story at: http://tinyurl.com/8xj3qc8
Source: FierceHealthcare
Urticaria Diagnosis Challenged by Overlapping Pruritic Skin Conditions
April 23rd 2025Urticaria is complicated to diagnose by its symptomatic overlap with other skin conditions and the frequent misclassification in literature of distinct pathologies like vasculitic urticaria and bullous pemphigus.
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New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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