Tag: Medicaid programs.


Four Common Forms of Virtual Care Reimbursed in Half of US States

According to a recent report, 25 states now provide reimbursement for video, store-and-forward, and audio-only telehealth, as well as remote patient monitoring through Medicaid. Although every state and Washington, D.C. include some form of live video-based telehealth in their Medicaid programs, only 25 of them also offer Medicaid reimbursement for live video, store-and-forward telehealth, remote […]
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Challenges in Insurance Reimbursement

Top 4 Challenges in Insurance Reimbursement Faced by Physicians

Access to beneficial healthcare is largely tied to insurance reimbursements for many Americans. Yet, despite their significance, physicians encounter various obstacles in obtaining these payments. Challenges involve inconsistent reimbursement schedules, payment audits, billing errors, unforeseen denials, lengthy appeals, and services falling outside coverage. These issues can hinder timely care, disrupt service continuity, and leave medical […]
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5 Mid-Year Medicaid Expansion Updates

Of the 12 states that have not expanded their Medicaid programs, four have taken legal, legislative, and/or budgetary actions this year with varying results. The Kaiser Family Foundation (KFF) has updated its state Medicaid expansion tracker, highlighting 2022 activity through July. The following summarizes activity in both expansion and non-expansion states. In January 2022, Georgia […]
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How Ending the Public Health Emergency Impacts Medicaid Spending

  States should prepare for fluctuations in Medicaid spending on nonelderly acute care after the declaration ends. The end of the coronavirus public health emergency declaration could lead to a shift in Medicaid spending for state Medicaid programs and federal Medicaid costs, according to a report from the Robert Wood Johnson Foundation and Urban Institute. […]
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CMS Updates Healthcare Worker Vaccine Mandate Guidance

CMS has issued interpretative guidance on its healthcare worker vaccine mandate following the Supreme Court’s decision to allow the mandate to be enforced while some states challenge it in courts. The guidance released a day after the Supreme Court ruling states that facilities participating in Medicare and Medicaid in 24 states must ensure their employees […]
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Direct-to-Consumer Telehealth Platforms Lag Behind Competition

The pandemic has changed patients’ use and perceptions of healthcare organizations. The question remains: Will those changes here to stay? PATIENTS PREFER TELEHEALTH SERVICES FROM DOCTORS, HEALTH PLANS Most telehealth users accessed virtual care services through their regular doctor or health plan as opposed to direct-to-consumer telehealth platforms, according to new data from Morning Consult. […]
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Steps Employers Can Take To Implement Advanced Primary Care

Advanced primary care can help employers control costs and coordinate care, but many employers do not know how to start and scale such a solution in their employer-sponsored health plans, according to a report from the Duke-Margolis Center. Primary care is an essential part of preventing high-cost health conditions among employees. However, only slightly more […]
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The Biden Administration Drug Plan Includes Value-Based Payment Ideas for Medicare

The administration said it would make the results of its drug price negotiations with manufacturers, as well as its approach to value-based care models, open to a variety of payers. The Biden administration Thursday released its plan to reduce prescription drug prices, which would include the use of models to test value-based payments in Medicare […]
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Pros, Cons of Non-Emergency Medical Transportation Benefits

MACPAC’s June 2021 report to Congress included findings about non-emergency medical transportation benefits in Medicaid programs that could prove useful for benefits design. A small fraction of the Medicaid population utilizes non-emergency medical transportation (NEMT) benefits, but for that community of beneficiaries NEMT programs can be indispensable, a MACPAC report recently found. It has been […]
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