Reimbursement

Hospitals are doing their part in cost control by streamlining care, cutting readmissions, adopting new reimbursement models so big pharma must shift focus off marketing and onto its own cost-cutting, the groups say.

Thomas Jefferson University Hospital has embarked on an initiative that is yielding insights that could prove valuable to any hospitals looking for ways to avoid federal reimbursement penalties from the Centers for Medicare and Medicaid Centers.

The acquisition of Medicaid insurance plan Fidelis in New York is moving forward.

AHIP CEO Matt Eyles says a proposed rule from the Centers for Medicare and Medicaid Services would result in more uninsured Americans and leave sicker, riskier patients in ACA marketplaces, ultimately driving healthcare costs higher.

The court order covers all insurers offering qualified health plans in the Affordable Care Act market for the 2017 or 2018 benefit year.

The insurer is partnering with five medical groups to rollout the reimbursement option with the goal of improving patient experience by reducing complications, duplications and readmissions.

America's Health Insurance Plans is among organizations asking Azar, HHS to stop the routing of dialysis patients who are eligible for Medicare, Medicaid to individual coverage carrying higher reimbursement rates.

With transfers to larger hospitals comes a high cost burden, making it important for community-based organizations to strike the appropriate balance.

American Medical Association and the American Society of Addiction Medicine are preparing to pilot test a model that pays for care including medications combined with psychosocial support.

Proposed legislation would allow pre-deductible coverage at onsite and retail clinics for treatment of primary, chronic and preventative care.