Category: Medical Billing

PBMs tend to Dominate State and Local Markets

PBMs tend to Dominate State and Local Markets

Pharmacy benefit managers (PBMs) tend to dominate state and local markets where they provide services to commercial health insurers across the United States. That could mean patients are stuck with higher prescription drug prices, according to new research published by the American Medical Association (AMA). The Policy Research Perspective report, “Competition in Commercial PBM Markets […]
Learn More
CMS System Edits Reduced Medicare Overpayments to Hospitals

CMS System Edits Reduced Medicare Overpayments to Hospitals

Medicare overpayments totaled $39.3 million between September 2016 and December 2021, but most of those improper payments occurred before CMS corrected its system edits error in May 2019. CMS system edits helped reduce Medicare overpayments to acute care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, a report from the […]
Learn More
State Surprise Billing Laws Impact Out-of-Network Provider Charges

State Surprise Billing Laws Impact Out-of-Network Provider Charges

Provider charges for out-of-network care increased by $1,157 after the passage of state surprise billing laws that allow arbitrators to consider provider charges in a surprise billing dispute. State surprise billing laws that allow arbitrators to consider provider charges when determining out-of-network payment amounts for surprise medical bills led to an increase in billed charges […]
Learn More
Value-Based Revenue Makes up 6.74% of Primary Care Income

Value-Based Revenue Makes up 6.74% of Primary Care Income

MGMA report shows value-based contracts account for $30,922 per provider The Medical Group Management Association released a report looking at the proliferation of value-based contracts and how quality metrics tie-in to revenue. The report, 2022 MGMA DataDive Practice Operations, shows that revenue from value-based contracts accounted for varying amounts of total medical revenue in 2021 […]
Learn More
Coding Drives Up Medical Billing Costs in US

Coding Drives Up Medical Billing Costs in US

Another study confirms that medical billing costs in the US significantly exceed those in similar countries, but researchers now know why: coding drives up US administrative spending. Complex coding structures in the US are driving up medical billing costs in the US, making it one of the most expensive countries to get paid, according to […]
Learn More
x