Editor's Note Fallout from the February 21 cyberattack on Change Healthcare continues to threaten physician practices and their patients nationwide, with respondents to a recent American Medical Association (AMA) survey indicating difficulties with insurance claims and eligibility verification. AMA published the results of the informal survey April 10. Conducted March…

Read More

Editor's Note Addressing social determinants of health (SDOHs), strengthening emergency preparedness, and improving maternal heath are among the top priorities of the fiscal year (FY) 2025 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) rules released April 10. These and other efforts aim to…

Read More

Editor's Note Private payers initially deny reimbursement on 15% of claims, only to later approve more than half of those initial denials, according to a national survey of healthcare institutions published March 21 by Premiere, Inc. Additionally, the denied claims on average tend to be more prevalent for higher-cost treatments…

Read More

Editor's Note Becker’s ASC Review on February 13 published an in-depth overview of the ambulatory surgery center (ASC) sector's growth and activity in 2023. It highlights the ongoing trends, market dynamics, regulatory changes, and notable company performances within the industry. Here are some takeaways: Growth and consolidation: The ASC sector…

Read More

Editor's Note In a March 9 Press release, CMS announced it will offer emergency funding for healthcare providers experiencing continued disruptions in the wake of a February 21 cyberattack on Change Healthcare, a subsidiary of UnitedHealthGroup and a major processor of medical claims. According to the release, CMS will extend…

Read More

Editor's Note Since the pandemic, the view of the healthcare industry in congress has essentially gone from “hero to zero” – a shift with potentially big implications for the healthcare business leaders gathered at yesterday’s closing session from Soumi Saha, PharmD, JD, senior vice president of government affairs at Premier…

Read More

Editor's Note The Department of Health and Human Services (HHS), in collaboration with the Centers for Medicare & Medicaid Services (CMS), announced a new initiative to ensure public access to emergency healthcare and assist hospitals in fulfilling obligations under the Emergency Medical Treatment and Labor Act (EMTALA), a CMS January…

Read More

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…

Read More

Editor's Note: Non-monetary compensation to physicians is limited to no more than $507 for calendar year 2024, according to a report on the federal Stark Law published December 27 in Lexology. The Stark Law applies to non-cash or cash-equivalent payments from hospitals, physician groups, labs and other provider entities. The…

Read More

Takeaways • The Joint Commission eliminated 56 redundant or outdated Elements of Performance, revised four others, and is using more checklists. • The Joint Commission is emphasizing healthcare equity and identifies it as a priority to address healthcare quality and safety, calling organizations to integrate health equity into their QAPI…

Read More