Reimbursement

Coverage of digital medicine CPT codes varies wildly, which makes it difficult for physicians to reliably provide digital services.

At least 7.1 million Medicaid enrollees have been disenrolled as of September 20, according to KFF.

New AMA research sheds light on the coverage policies of 16 commercial health insurers.

Costs for procedures such as mammograms and colonoscopies are as much as 58% higher when performed in HOPD settings.

For both primary and specialty care, telehealth is more frequently coded with a lower level-of-service billing code, Epic Research says.

Because health organizations are paid by capitation, incentives are aligned to keep the patient healthy, says Ran Balicer, chief innovation officer at Clalit Health Services.

CareSignal, which is part of Lightbeam, takes population health enablement strategies and metrics to clinicians, says CareSignal CEO Blake Marggraff and Lightbeam president Jerry Shultz.

Medicare, through CPT code development, sets the lead for how digital health gets paid, says Brian Scarpelli, executive director of the Connected Health Initiative.

IT, telehealth, clinical decision support, wellness tools and diagnostics all fall into the same category, says Jessica Hauflaire, COO of the Digital Therapeutics Alliance. Digital therapeutics consist of software as a direct intervention to treat, manage or prevent medical conditions.

VP of operations David Murtagh, at MultiPlan, which cofounded the Synaptic Health Alliance with United Healthcare, Humana and others, will speak at HIMSS23 about emerging use cases for distributed ledger technology for payers and providers.