Reimbursement

The Centers for Medicare & Medicaid Services published a proposed rule Wednesday that establishes financial integrity standards to oversee qualified health plans (QHPs) offered in health insurance exchanges and for states around their operation of risk adjustment and reinsurance programs under the Affordable Care Act.

The Food and Drug Administration has relaxed certain requirements for using fecal microbiota therapy in Clostridium difficile infections, a decision that may encourage payers to consider coverage options for the treatment.

Patients are responsible for nearly one-quarter of their medical bill on average through the cost of co-pays, deductibles and co-insurance, according to the latest National Health Insurer Report Card from the American Medical Association (AMA).

Nontraditional care delivery models, such as accountable care organizations (ACO), patient-centered medical homes (PCMH) and shared-savings programs, have been gaining traction in the healthcare arena, with more than half of physicians and other industry professionals now participating in these programs, according to new survey findings released Monday. 

Overall U.S. healthcare prices remained flat from April to May 2013, according to the federal Bureau of Labor Statistics.

National Coordinator for Health Information Technology Farzad Mostashari, MD, spoke with Healthcare IT News Senior Editor Diana Manos Monday at the HIMSS Media ICD-10 Forum in  National Harbor, Md.  With his typical candor and energy, Mostashari commented on several healthcare IT issues and about ICD-10 – the focus of the forum and the topic of the keynote talk he had delivered earlier in the day. Yes, he was wearing his signature bow tie.

With so many reimbursement considerations to think about with the transition to ICD-10, such as reduced cash flow and an increase in denials and audits, the best defense for healthcare systems is to know what to expect and begin preparing for the changes now.

In a competitive healthcare marketplace like Dallas-Ft. Worth, it's essential that a physician practice tightly manage its revenue cycle. Texas Health Physicians Group is doing that by tracking five key financial metrics.

So-called "pay for delay" deals between patent-holding pharmaceutical firms and would-be generics makers can now be challenged on antitrust grounds, although they are not necessarily anti-competitive, the U.S. Supreme Court has ruled.

The Medicare Payment Advisory Commission (MedPAC) has found that hospitals with a large portion of low-income patients also have higher readmission rates, and, therefore, higher penalties under Medicare's hospital readmissions reduction program.