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Reimbursement

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Backers of Prior Authorization Bill Hopeful for Passage by End of the Year

The bill's cost estimate has dropped from $16 billion to $0, greatly hiking chances of passage

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House Members Introduce Bill to Reverse Pending Medicare Physician Fee Schedule Cut

Measure includes a 1.8% pay increase for clinicians

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A Look at the Supreme Court's Upcoming Term

Public health is on the chopping block once again

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UVA Health Surgeons Sound Alarm on Upcoding

Leaked meeting audio latest development in ongoing strife at health system, medical school

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Use of Prior Authorization Up in Medicare Advantage Plans, Senate Report Finds

Post-acute care services targeted for coverage denials

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Want Electronic Reimbursement? That Will Cost You a 5% Fee.

Predatory insurance fees underscore need for physician payment reform

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Stop the Medicare Payment Cut and Pass a Permanent Fix, House Members Urge Leaders

The Medicare fee schedule is "inherently broken," says bipartisan letter from 233 members

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Billing for Patient Messages May Have Negative Consequences, Analysis Suggests

A survey showed that physicians and patients were concerned about the effects of such fees

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Doctors Cut Back on Seeing Medicare Patients as Another Pay Cut Looms

Those still seeing Medicare patients struggle to stay in private practice

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Is Healthcare Really Recession-Proof?

The answer is complicated

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Healthcare Unionization Isn't the Only Option

In this changing workplace, managers and leaders can do better for their staff

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Reproductive Rights Central to Wisconsin Ob/Gyn's Run for Congress

Medicare physician pay, healthcare-for-all also central to Kristin Lyerly's campaign

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Mental Health Parity Rule Lauded by Healthcare Groups

Plans will be barred from using more restrictive prior authorization rules for mental health care

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Common-Ground Healthcare Policies Both Trump and Harris Can Support

Can our future leaders place public health ahead of politics?

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CMS Drops Controversial Proposal for Blood Tests After Organ Transplant

Test supporters call the move a "win"; agency will issue a new proposal "in the coming months"

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Is Medicare's Negotiated Drug Price List Worth Celebrating? Depends on Whom You Ask.

Reactions from physician and consumer groups were positive, but drugmakers begged to differ

Medicare Unveils First 10 Negotiated Drug Prices

Prices slashed by as much as 79%

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Prior Authorizations on the Rise in Medicare Advantage, Report Finds

Increase corresponds to a climb in Medicare Advantage enrollment

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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

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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

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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

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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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