Tag: physician reimbursement

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 […]
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Medicare, Beneficiaries Saw Higher Prices at Provider-Based Facilities

Medicare, Beneficiaries Saw Higher Prices at Provider-Based Facilities

The Medicare program and Medicare beneficiaries could have saved a combined $1.6 billion if provider-based facilities charged the same payment rate as freestanding facilities, OIG found. Medicare and its beneficiaries paid significantly higher prices at provider-based facilities than they would have paid to freestanding facilities for the same services, according to a report from the […]
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MGMA Requests Updates to Independent Dispute Resolution Portal

MGMA Requests Updates to Independent Dispute Resolution Portal

The organization recommended CMS update the independent dispute resolution portal to improve communication between disputing parties and adjust the form field requirements. The Medical Group Management Association (MGMA) has asked CMS to update the federal independent dispute resolution (IDR) portal to streamline the arbitration process for determining an out-of-network payment rate for a surprise medical […]
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AMA Challenges MedPAC Suggestion to Freeze Medicare Physician Payment

AMA Challenges MedPAC Suggestion to Freeze Medicare Physician Payment

The industry group states that Medicare physician payment bump will hinder the delivery of high-quality care as providers face financial burdens. MedPAC, a panel tasked with advising Congress on issues impacting the Medicare program, voted to recommend no increase to 2023 Medicare reimbursement rates for physicians. “Temporary or high variable coronavirus effects are best addressed […]
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6 BEST REIMBURSEMENT STORIES OF 2021

6 BEST REIMBURSEMENT STORIES OF 2021

  Here are the six best reimbursement stories from 2021 HealthLeaders’ coverage and beyond. COVID-19 continued to impact healthcare reimbursement as the pandemic entered its second year. Yet, what’s different is that longer-term strategies and new business opportunities are emerging beyond crisis response. The Centers for Medicare & Medicaid Services (CMS) aided these plans by […]
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CMS Releases Final Rule for CY 2022 Medicare Physician Fee Schedule

CMS Releases Final Rule for CY 2022 Medicare Physician Fee Schedule

CMS has finalized the calendar year (CY) 2022 Medicare Physician Fee Schedule to promote greater telehealth utilization, boost reimbursement rates for vaccine administration, and improve health equity, among other initiatives, the federal agency said. The final rule will implement “a series of standard technical proposals” as part of CY 2022 rate-setting, CMS said. The conversion […]
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$4.8B to COVID-19 Testing Reimbursement for the Uninsured

$4.8B to COVID-19 Testing Reimbursement for the Uninsured

HHS will designate $4.8B from the American Rescue Plan to COVID-19 testing reimbursement under the HRSA COVID-19 Uninsured Program. Under the Health Resources and Services Administration (HRSA), HHS announced it will allocate $4.8 billion to COVID-19 testing reimbursement for the uninsured as part of the American Rescue Plan. There are currently approximately 29 million uninsured […]
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