CVS Health pushes forward with efforts to reshape segments of the healthcare industry
About two decades after adding the first three MinuteClinics to its stores, in 2005, CVS Health continues to grow as one of the biggest disruptors in healthcare. The company has embarked on a series of strategic transactions that make it a major player across an increasingly large swath of the industry, as described this month…
Time to take a fresh look at affiliation options for physicians and health systems
As the healthcare marketplace continues to evolve, posing new challenges and creating new opportunities, so too will affiliation models continue evolve in ways that can best meet current and future needs of healthcare providers. In this environment, health systems and physician practices — both independent and employed — could benefit from taking a fresh look…
During a potentially tumultuous Congress, healthcare stakeholders should communicate their policy priorities
With the 118th Congress bringing the potential for policy upheaval, one of the best things healthcare stakeholders can do is make themselves heard on Capitol Hill. The new Republican majority in the House of Representatives has signaled its intent to use the federal debt ceiling as leverage in budget negotiations. President Joe Biden and the…
Key points to know in recently proposed rules for Medicare Advantage and the ACA marketplaces
A proposed rule for health plans in Medicare Advantage has provisions designed to stem overreach in prior authorization processes.
Seeking to phase out Medicare DSH payments, MedPAC outlines potential changes to reimbursement for safety net providers
Revamped formulas for hospitals and physicians would be designed to better target payments to providers that treat larger shares of low-income Medicare beneficiaries.
Remedies for 340B underpayments remain up in the air after court declines to provide guidance
A federal court is allowing HHS to decide on remedies covering Medicare underpayments to hospitals for 340B drugs.
Labor costs and other concerns dampen the outlook for not-for-profit hospitals this year
Insights from a leading credit-rating agency illustrate the scope of the financial challenges facing not-for-profit hospitals in 2023.
4 tips for simplifying prior authorizations
Healthcare spending in the U.S. has reached what many consider to be unsustainable levels. While spending in other developed nations averaged 8.8% of GDP in 2019, it was nearly double that in the U.S. at 16.8%. One of the major contributors to this spending is administrative waste, which accounts for up to 30% of our…
Medicare contractors should more closely examine providers’ bad debt claims, HHS watchdog says
Medicare administrative contractors (MACs) soon could apply more scrutiny to providers’ reported bad debts if CMS implements recommendations from the HHS Office of Inspector General (OIG). OIG in December issued a report in which it examined bad-debt reimbursement claims on Medicare cost reports spanning 2016 through 2018 for 67 randomly selected providers (including 29 hospitals). In those…
For the No Surprises Act arbitration process, 2023 brings a steep fee hike and continuing litigation
The No Surprises Act’s independent dispute resolution (IDR) process is about to become more expensive for healthcare stakeholders. In 2023, the nonrefundable administrative fee due from each party involved in any payment dispute that goes to arbitration will increase from $50 to $350, according to a Dec. 23 memo from CMS’s Center for Consumer Information and Insurance…