Healthcare pricing update: 2 experts call for greater regulation
Recent price increases have been slower in healthcare than in the economy at large, but two healthcare economists say the long-term price trends should be addressed through regulation.
8 ways healthcare providers can smooth the DRG audit process
A health system’s financial sustainability depends on its being paid appropriately for the services it delivers. Yet routine payer audits can all too often result in downgrades of a health system’s billed diagnosis-related groups (DRGs), resulting in lower payment. It therefore behooves health systems to be well prepared for such audits and thoroughly understand why payers’ are most inclined to take such action.
Federal judge rules for providers in a case about a key component of the new surprise billing regulations
A federal judge found in favor of the Texas Medical Association in a case about the arbitration process that is being implemented as part of the No Surprises Act.
Small study finds health systems lagging in providing value-based payment incentives to physicians
Despite the increasing proliferation of alternative payment models, a new study finds that health systems generally don’t give physicians financial incentives to improve the value of care delivery.
Large analysis of hospital websites finds little compliance with price transparency regulations
Fewer than 15% of hospitals are fully compliant with federal price transparency regulations, according to an analysis.
HHS’s Office of Inspector General announces audit of providers’ COVID-19 billing practices
OIG has announced an audit of Provider Relief Fund recipients to ensure they did not balance-bill presumptive or actual COVID-19 patients.
Healthcare stakeholders are invited to contribute suggestions for improving prior authorization
A two-month comment period is available for healthcare stakeholders to suggest electronic standards that would make the prior authorization process more efficient.
Coverage denials based on medical necessity are far more likely to arise from Medicare FFS rules than from MA plan policies
Coverage rules stemming from Medicare national and local determinations were the most likely cause of claim denials in one Medicare Advantage plan.
New surprise billing regulations: Assessing a patient’s network status will be a key challenge
With new surprise billing regulations in place, providers should seek to implement efficient processes for gauging whether a patient is in-network.
2 new studies illustrate the burden of healthcare costs in the pandemic era
An annual report by CMS actuaries quantified the extent to which healthcare costs accelerated during the first year of the COVID-19 pandemic, while a separate survey looked at affordability.