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Reimbursement

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Alternative PBMs Arise to Compete With the 'Big Three'

Competitors say their per-member, per-month payment model is fairer to employers and insurers

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Extend the Hospital-at-Home Waiver Before It's Too Late

Older adults should continue to receive care where they feel and heal their best

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PBMs Overpay Their Own Pharmacies to the Detriment of Insurers, Taxpayers, FTC Says

But the interim report was criticized by business owners and the PBM trade group

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Another Medicare Cut for Physicians? Look to Congress, Not CMS

Medicare patients and providers deserve better

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Senate Hearing on Noncompete Agreements Gets Contentious

Sen. John Kennedy spars with orthopedic surgeon who fought to leave his practice

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CMS Allows State to Offer Medicaid Incentive for Hospitals to Erase Patient Debt

North Carolina's plan could help 2 million low- and middle-income people get rid of medical debt

A photo of Rich McCormick.

Health Should Be a Bigger Focus at the GOP Convention Than It Will Be, Lawmaker Says

"I wish it was the centerpiece of everything we're talking about," says Rep. Rich McCormick, MD

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Devaluing Our Residents Is Not Without Consequences

Let's take better care of our young medical workforce

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What Can Be Done About Medical Debt?

Senators, witnesses mull solutions ranging from more competition to Medicare for All

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CMS Proposes 2.8% Cut to Medicare Physician Fees for 2025

One group calls proposal "critically short-sighted"

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CPT Code for Prior Authorization May Still Happen -- Eventually

Proposal would cover more than existing codes for limited situations

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Why Is Doctor Pay Decreasing and What Can We Do About It?

It's time to take back control of our profession

A screenshot of Robert Berenson, MD speaking during this hearing.

CMS Needs to Do a Better Job With Value-Based Care, Experts Tell House Panel

The program has "gotten off track and needs a thorough reevaluation and reformulation," doc says

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Eyes Off the Prize: Prior Auth Snags Force Delays in Ocular Treatment

While insurers rarely reject requests, they can take weeks to approve anti-VEGF injections

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Health Groups Have High Hopes for the Latest Prior Authorization Bill

"We believe the bill is poised for adoption this year," said one expert

A photo of Bobby Mukkamala, MD

Medicare Pay, Prior Auth, and More: A Q&A With the AMA's President-Elect

Bobby Mukkamala, MD, also says he wants to improve medical record interoperability

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Fix What's Broken in Healthcare Is New AMA President's Priority

That includes raising Medicare reimbursement and lessening prior authorization, says Bruce Scott

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Increase $$ for Physicians, Institute Site-Neutral Payment, MedPAC Report Suggests

Inadequate payments could force some docs to stop accepting Medicare patients, commission warns

A screenshot of Representative Rep. Morgan Griffith speaking during this hearing.

House Committee Divided on Whether Changes are Needed in 340B Drug Discount Program

Program's value undisputed, but some members say hospitals are taking unfair advantage

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What if Medicaid Enrollees Were Given Cash Instead of Insurance Benefits?

Having them buy insurance or pay for services directly would bring down prices, supporters say

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MGMA: Docs 'Defy Gravity' of Inflation, Staff Shortages by Working Harder

Report shows which of 23 specialty groups and primary care practices earned more in 2023

A screenshot of Timothy Richardson, MD, speaking during this hearing.

More Money, Fewer Prior Auths Needed to Save Private Practices, Lawmakers Told

Medicare rates' failure to keep up with inflation is especially damaging, doctors say

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Senate Paper Mulls Options for Fixing Physician Pay in Fee-for-Service Medicare

Regular inflation updates, getting rid of MIPS among the ideas discussed

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Revisiting 'Left Without Being Seen' Metrics in the ED

The current system drives problematic decisions regarding how care is allocated

A photo of Jerome Adams, MD, MPH

I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

Everyone must be able to access necessary care without fear of financial ruin

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Fraudulent Practices Abound in Post-Accident Healthcare

These costs often fall unfairly on patients and insurance providers

A screenshot of Sheldon Whitehouse speaking during this hearing.

Pre-Approval Plan Proposed for Medicare Advantage Insurers

"No prior authorization without prior authorization," Senate Budget Committee chair says

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Medicare Hospital Trust Fund to Stay Solvent Until 2036, Trustees' Report Says

Projection is 5 years longer than last year's prediction

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Fed Up With Prior Auths? What if Insurers Had to Pay You for Submitting Them?

NYC urologist is seeking approval for a prior authorization CPT code

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The Plight of the Late-Boomer Physician

Does anyone besides me feel like we got the short end of the financial stick?

A screenshot of UnitedHealth CEO Andrew Witty speaking during this hearing.

UnitedHealth CEO Slammed at Senate Hearing on Change Healthcare Cyberattack

"A comprehensive scrub" of company's anti-competitive practices is long overdue, senator says

A screenshot of Daniel Tsai speaking during this hearing.

House Republicans Bash New Nursing Home and Home Care Rules at Hearing

"This approach simply won't work," said chair of the House Energy & Commerce Health Subcommittee

A photo of Adam Bruggeman, MD speaking during this hearing.

Lawmakers Take Up Fallout From Change Healthcare Cyberattack

Health sector likely to remain an "attractive target," says congressman

A screenshot of Frank Pallone speaking during this hearing.

Improper Payments in Medicare and Medicaid: Who's at Fault?

Republicans and Democrats took differing approaches on the subject at a House hearing

Federal Probes Need to Look Beyond Private Equity-Owned Healthcare for Alleged Abuse

Non-profit entities should also be fair game, says Ron Harman King, JD, MS

A screenshot of Lee Schwamm, MD, speaking during this hearing.

House Members Struggle to Craft Road Map for Future of Telehealth

Lawmakers examine issues around reimbursement, licensure, and patient choice

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Biden Administration Cracks Down on 'Junk' Health Insurance Plans

Under final rule, insurers will have to spell out what these policies do not include

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Medicare Debuts Another Primary Care-Focused Accountable Care Model

Primary Care Flex will pay ACOs a monthly fee to be given to primary care practices

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Medicare to Cover Weight-Loss Drug Wegovy for Certain Patients

News comes in the wake of FDA approval to reduce risk of heart attacks, stroke

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California Wants to Pay Doctors More Money to See Medicaid Patients

How much and who will get it will be determined later this year

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