Tag: Medicaid

Shift to outpatient, emergency services keeps rural hospitals afloat

Editor's Note More CEOs are considering rural emergency hospital (REH) designation, according to a February 12 article in Becker’s Hospital CFO Report. In 2021, REH was established as a new Medicare provider type to enable struggling rural hospitals to continue operating with outpatient and emergency services only, instead of closing.…

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By: Matt Danford
February 27, 2024
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CMS reforms prior authorization to improve care, streamline physician process

Editor's Note The Centers for Medicare & Medicaid Services (CMS) has implemented a final rule reforming the prior authorization process, with the aim to reduce delays in patient care and boost electronic efficiency for physicians, the American Medical Association (AMA) News Wire reported January 23. The Department of Health and…

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By: Tarsilla Moura
January 23, 2024
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Bipartisan congressional letter calls for end to Medicare payment cuts

Editor's Note Nearly 200 members of Congress co-signed a letter urging House and Senate leaders to act quickly in order to prevent a 3.37% cut to Medicare reimbursement payments that was scheduled to take effect on January 1, 2024. The American Medical Association, which supports the effort, reported the news…

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By: Brita Belli
January 10, 2024
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Why screening misses critical influences on patient health

Editor's Note Health record codes that track social, environmental, and economic influences on patient health outcomes are vastly underutilized during screening, according a December 19 EurekAlert! report on research from John Hopkins and the University of Colorado Anschutz Medical Campus.   Published in Health Affairs Scholar, the study analyzes the…

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By: Brita Belli
December 19, 2023
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Bill seeks to improve cost transparency, provide relief to patients

Editor's Note The US House of Representatives may vote this week on The Lower Costs, More Transparency Act. Introduced September 8, the proposed act aims to boost healthcare pricing transparency so consumers can make more informed decisions. Key elements include: Hospitals, payers, ambulatory surgery centers (ASCs), and other facilities would…

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By: Brita Belli
December 11, 2023
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ASCs lock in higher Medicare, Medicaid payment rate

Editor's Note Ambulatory Surgery Centers (ASCs) will now receive a 3.1% payment rate from the Centers for Medicare and Medicaid Services (CMS) for services, which is an increase of .3% under the original rule, Becker’s ASC Review December 5 reports. This change in payment rate reflects the average of all…

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By: Brita Belli
December 8, 2023
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Healthcare costs making Americans poorer, sicker

Editor's Note The high cost of healthcare is leading many Americans to skip care and forgo medications, according to the 2023 Healthcare Affordability Survey by the Commonwealth Fund published on October 26. Some highlights of the survey include: A large number of insured working-age adults surveyed admitted difficulty affording their…

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By: Brita Belli
November 2, 2023
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New agreement between HHS, Pfizer to ensure access to Paxlovid

Editor's Note The US Department of Health and Human Services (HHS) and Pfizer have announced an agreement to extend patient access to the COVID-19 drug Paxlovid, Healthcare Purchasing News October 16 reports. According to the article, Pfizer is readying the drug for more availability in the commercial market in November…

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By: Brita Belli
October 19, 2023
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Problems with prior authorization, utilizing health insurance coverage are prevalent, survey finds

Editor's Note This KFF survey from June 2023 found that some six in 10 adults with health insurance have experienced problems when trying to use their insurance, KFF Health News September 29 reports. The problems included denied claims, network adequacy issues, and preauthorization delays and denials.  According to the survey,…

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By: Brita Belli
October 4, 2023
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Effect of Medicaid expansion on reductions in preventable hospitalizations

Editor's Note This study, led by researchers at Wake Forest University School of Medicine, Winston-Salem, North Carolina, examines whether Affordable Care Act Medicaid expansion among Black, Hispanic, and White patients led to reductions in preventable hospitalizations. Data on census population and hospitalizations for ambulatory care sensitive conditions from 2010 to…

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By: Judy Mathias
September 13, 2023
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