Medicaid Managed Care Overhaul Could Follow Election
Oct. 23—A so-called mega rule to overhaul federal standards for Medicaid health plans could come days after the midterm election, an industry leader said this week.
Understanding the 7 Options for CMS’s Hospital Charge Posting Rule
Hospitals can choose to post charges in a variety of ways, but not all methods comply with CMS’s recent rule that takes effect on Jan. 1, 2019.
Comprehensive Compliance-Focused Processes for Physician Arrangements
Karin Chernoff Kaplan reviews the basics—and the importance—of establishing consistent processes for setting up and managing physician compensation agreements and thresholds that avoid regulatory problems.
What Changes Are Coming to Medicaid in 2019?
Oct. 16—Additional state expansions of Medicaid eligibility are among the expected developments coming next year to the program, according to a former federal leader of Medicaid.
The Controversy over the Rules of the Game for the Medicare Shared Savings Program
Ken Perez examines the fundamental disagreement over how MSSP ACO savings are being measured and the potential fallout as participants consider leaving the program.
More than 1,500 Provider Organizations Join New Bundle
Oct. 9—The latest Medicare bundled payment model gained 50 percent more provider organizations than its predecessor.
Transitioning to a New Medicare Benchmarking Paradigm
As commercial health plans adopt a case-rate approach to payment based on Medicare’s MS-DRGs, modifications are needed to account for how health plans’ populations differ from the Medicare population.
Success Factors for Getting High-Cost Drugs Approved
The University of Rochester Medical Center’s high-cost drug manager works to help patients get access to appropriate drugs and mitigates the financial risk associated with buying and administering them.
Ask the Experts: Lesser-Than Provisions
What specific pitfalls should we look for in terms of lesser-than provisions?
The Conscience of the Generic Drug Market
Created to address the high costs and shortages of generic medications, the not-for-profit generic drug manufacturer Civica Rx aims to be a societal asset by providing patients across the nation with affordable access to the medications they need.