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Reimbursement Topic Center

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Medicare Cuts Payment to 774 Hospitals Over Patient Complications
02/24/2021
Renowned medical centers are among the quarter of general hospitals that will lose 1% of Medicare payments for one year because their patients have high rates of bedsores, sepsis and other preventable complications.
Renowned medical centers are among the quarter of general hospitals that will lose 1% of Medicare payments for one year because their patients have high rates of bedsores, sepsis and other preventable complications.
Renowned medical centers are...
02/24/2021
First Report Managed Care
From First Report Managed Care
The Ideal Elective Surgery During a Pandemic
Commentary
The Ideal Elective Surgery During a Pandemic
02/18/2021
This article explains how David Silver, MD, chief of urology and director of the Prostate Center at Maimonides Medical Center, changed his treatment decisions amid the pandemic, and highlights the use of the new CPT code for high intensity...
This article explains how David Silver, MD, chief of urology and director of the Prostate Center at Maimonides Medical Center, changed his treatment decisions amid the pandemic, and highlights the use of the new CPT code for high intensity...
This article explains how David...
02/18/2021
Population Health
News
Decreased Medicare Reimbursement to Physicians Over Last 20 Years for Common Arthroscopic Procedures
12/17/2020
Researchers of a recent study recently found that over the last 20 years, Medicare reimbursement to physicians has decreased by nearly 30% for the most common arthroscopic procedures.
Researchers of a recent study recently found that over the last 20 years, Medicare reimbursement to physicians has decreased by nearly 30% for the most common arthroscopic procedures.
Researchers of a recent study...
12/17/2020
First Report Managed Care
From First Report Managed Care
News
Increased Collaboration Needed Among Hospitals Participating in Bundled Payment Programs to Improve Info Sharing
12/14/2020
“The greater need for collaboration of hospitals participating in bundled payment programs was associated with greater information sharing among organizations through HIE, but different providers involved in the episode of care play different...
“The greater need for collaboration of hospitals participating in bundled payment programs was associated with greater information sharing among organizations through HIE, but different providers involved in the episode of care play different...
“The greater need for...
12/14/2020
First Report Managed Care
From First Report Managed Care
News
Reviewing Reimbursement Statutes, Regulations for Pharmacist-Provided Health Care Services
11/24/2020
Researchers of a recent study compared six different states’ approaches to reimbursement for pharmacist-provided health care services and found that significant differences can lead to further variability in compensated services and...
Researchers of a recent study compared six different states’ approaches to reimbursement for pharmacist-provided health care services and found that significant differences can lead to further variability in compensated services and...
Researchers of a recent study...
11/24/2020
First Report Managed Care
From First Report Managed Care
News
Examining Trends for Medicare Reimbursement in Emergency Care Services
11/19/2020
“Knowledge of these trends is essential to address current controversies in emergency medicine billing adequately and advocate for sustainable payment system reform,” researchers explained.
“Knowledge of these trends is essential to address current controversies in emergency medicine billing adequately and advocate for sustainable payment system reform,” researchers explained.
“Knowledge of these trends is...
11/19/2020
First Report Managed Care
From First Report Managed Care
Understanding Reimbursement for Doctors Treating SNF Patients Via Telehealth
Podcasts
Understanding Reimbursement for Doctors Treating SNF Patients Via Telehealth
11/04/2020
Paul Knight, OT, MBA, founder and chief product officer, Curatess, discusses the wide variety of telehealth offerings now available for long-term care facilities and explains the reimbursement process for those treating SNF patients via...
Paul Knight, OT, MBA, founder and chief product officer, Curatess, discusses the wide variety of telehealth offerings now available for long-term care facilities and explains the reimbursement process for those treating SNF patients via...
Paul Knight, OT, MBA, founder...
11/04/2020
Annals of Long-Term Care
From Annals of Long-Term Care
News
CMS, CDC Announce Reimbursement Options for Counseling COVID-19 Patients
07/30/2020
As health care professionals continue to fight against COVID-19 and stop the spread, the CMS and CDC have announced that payment is available to physicians and providers who counsel patients during testing about isolation.
As health care professionals continue to fight against COVID-19 and stop the spread, the CMS and CDC have announced that payment is available to physicians and providers who counsel patients during testing about isolation.
As health care professionals...
07/30/2020
First Report Managed Care
From First Report Managed Care
News
Payer Reimbursement Differences in Diabetes Treatments: Public vs Private
04/15/2020
“This study highlights how differences in payer reimbursement rates for medications can lead to contrasting results,” said researchers of a recent study.
“This study highlights how differences in payer reimbursement rates for medications can lead to contrasting results,” said researchers of a recent study.
“This study highlights how...
04/15/2020
First Report Managed Care
From First Report Managed Care
Improved Reimbursement Options Needed for National Diabetes Prevention Program Providers
Interview
Improved Reimbursement Options Needed for National Diabetes Prevention Program Providers
03/17/2020
Jennifer Torres Mosst, PhD, program manager of Diabetes Strategies at the Division of Chronic Disease and Injury Prevention, explain why billing and reimbursement approaches play a critical role in the types of programs that can be...
Jennifer Torres Mosst, PhD, program manager of Diabetes Strategies at the Division of Chronic Disease and Injury Prevention, explain why billing and reimbursement approaches play a critical role in the types of programs that can be...
Jennifer Torres Mosst, PhD,...
03/17/2020
First Report Managed Care
From First Report Managed Care
Adoption of Value-Based Reimbursement Among Private Insurers
04/19/2019

Mary Beth Nierengarten

Mary Beth Nierengarten
As the federal government moves toward adopting and expanding value-based payment models, private market providers and payers are striving to smoothly transition to the new models, furthering the transformation of thought and practice of how...
As the federal government moves toward adopting and expanding value-based payment models, private market providers and payers are striving to smoothly transition to the new models, furthering the transformation of thought and practice of how...
As the federal government moves...
04/19/2019
First Report Managed Care
From First Report Managed Care

Newsfeed

News
Medicare Cuts Payment to 774 Hospitals Over Patient Complications
02/24/2021
Renowned medical centers are among the quarter of general hospitals that will lose 1% of Medicare payments for one year because their patients have high rates of bedsores, sepsis and other preventable complications.
Renowned medical centers are among the quarter of general hospitals that will lose 1% of Medicare payments for one year because their patients have high rates of bedsores, sepsis and other preventable complications.
Renowned medical centers are...
02/24/2021
First Report Managed Care
News
Decreased Medicare Reimbursement to Physicians Over Last 20 Years for Common Arthroscopic Procedures
12/17/2020
Researchers of a recent study recently found that over the last 20 years, Medicare reimbursement to physicians has decreased by nearly 30% for the most common arthroscopic procedures.
Researchers of a recent study recently found that over the last 20 years, Medicare reimbursement to physicians has decreased by nearly 30% for the most common arthroscopic procedures.
Researchers of a recent study...
12/17/2020
First Report Managed Care
News
Increased Collaboration Needed Among Hospitals Participating in Bundled Payment Programs to Improve Info Sharing
12/14/2020
“The greater need for collaboration of hospitals participating in bundled payment programs was associated with greater information sharing among organizations through HIE, but different providers involved in the episode of care play different...
“The greater need for collaboration of hospitals participating in bundled payment programs was associated with greater information sharing among organizations through HIE, but different providers involved in the episode of care play different...
“The greater need for...
12/14/2020
First Report Managed Care
News
Reviewing Reimbursement Statutes, Regulations for Pharmacist-Provided Health Care Services
11/24/2020
Researchers of a recent study compared six different states’ approaches to reimbursement for pharmacist-provided health care services and found that significant differences can lead to further variability in compensated services and...
Researchers of a recent study compared six different states’ approaches to reimbursement for pharmacist-provided health care services and found that significant differences can lead to further variability in compensated services and...
Researchers of a recent study...
11/24/2020
First Report Managed Care
News
Examining Trends for Medicare Reimbursement in Emergency Care Services
11/19/2020
“Knowledge of these trends is essential to address current controversies in emergency medicine billing adequately and advocate for sustainable payment system reform,” researchers explained.
“Knowledge of these trends is essential to address current controversies in emergency medicine billing adequately and advocate for sustainable payment system reform,” researchers explained.
“Knowledge of these trends is...
11/19/2020
First Report Managed Care
News
CMS, CDC Announce Reimbursement Options for Counseling COVID-19 Patients
07/30/2020
As health care professionals continue to fight against COVID-19 and stop the spread, the CMS and CDC have announced that payment is available to physicians and providers who counsel patients during testing about isolation.
As health care professionals continue to fight against COVID-19 and stop the spread, the CMS and CDC have announced that payment is available to physicians and providers who counsel patients during testing about isolation.
As health care professionals...
07/30/2020
First Report Managed Care
News
Payer Reimbursement Differences in Diabetes Treatments: Public vs Private
04/15/2020
“This study highlights how differences in payer reimbursement rates for medications can lead to contrasting results,” said researchers of a recent study.
“This study highlights how differences in payer reimbursement rates for medications can lead to contrasting results,” said researchers of a recent study.
“This study highlights how...
04/15/2020
First Report Managed Care
News
Oncologists Sue HHS to Stop Cancer Drug Reimbursement Cuts
05/31/2018
The Community Oncology Alliance has filed a lawsuit against the Trump Administration to stop a 2% cut to Medicare Part B reimbursements for cancer drugs.
The Community Oncology Alliance has filed a lawsuit against the Trump Administration to stop a 2% cut to Medicare Part B reimbursements for cancer drugs.
The Community Oncology Alliance...
05/31/2018
First Report Managed Care
News
Reimbursement Cuts on Lab Tests Pressure US Lab Firm Shares
11/20/2017
The CMS recently rolled out deeps cuts to reimbursement rates for some lab tests under Medicare.
The CMS recently rolled out deeps cuts to reimbursement rates for some lab tests under Medicare.
The CMS recently rolled out...
11/20/2017
First Report Managed Care
News
Medicare reimbursement not yet boosting advance care planning
07/04/2017
By Scott Baltic NEW YORK (Reuters Health) - Medicare’s reimbursement for advance care planning (ACP) appears to have been “largely ineffective” at encouraging clinicians in the U.S. to discuss ACP with their patients, at least in the first...
By Scott Baltic NEW YORK (Reuters Health) - Medicare’s reimbursement for advance care planning (ACP) appears to have been “largely ineffective” at encouraging clinicians in the U.S. to discuss ACP with their patients, at least in the first...
By Scott Baltic NEW YORK...
07/04/2017
Population Health
News
Increased Scrutiny of Prior Authorization: Are Payers Fully to Blame, and Can AI Improve the Process?
04/05/2024
Dean Celia
The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.
The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.
The increased scrutiny of prior...
04/05/2024
First Report Managed Care
News
PhRMA Maps Provide State-by-State Look at 340B Drug Program
04/05/2024
Paul Nicolaus
An interactive map made available by the Pharmaceutical Research and Manufacturers of America (PhRMA), a drugmaker advocacy group, shares state-specific data on the 340B Drug Pricing Program. The federal program, initially created over 30...
An interactive map made available by the Pharmaceutical Research and Manufacturers of America (PhRMA), a drugmaker advocacy group, shares state-specific data on the 340B Drug Pricing Program. The federal program, initially created over 30...
An interactive map made...
04/05/2024
First Report Managed Care
News
FTC and HHS Launch Joint Inquiry into Generic Drug Shortages: Seeking Public Input on GPOs and Wholesalers
02/16/2024

Danielle Sposato

Danielle Sposato
In a news release published on February 14, 2024, the US Department of Health and Human Services (HHS) issued a "Request for Information" in collaboration with the Federal Trade Commission (FTC). This request aims to gain insight into how...
In a news release published on February 14, 2024, the US Department of Health and Human Services (HHS) issued a "Request for Information" in collaboration with the Federal Trade Commission (FTC). This request aims to gain insight into how...
In a news release published on...
02/16/2024
First Report Managed Care
News
Medicare Drug Price Negotiations and Anticipated Ripple Effects
02/15/2024
Paul Nicolaus
The arrival of the Inflation Reduction Act has ushered in a new era of drug price regulation, giving the Centers for Medicare & Medicaid Services (CMS) the ability to negotiate directly with companies that make some of the costliest drugs...
The arrival of the Inflation Reduction Act has ushered in a new era of drug price regulation, giving the Centers for Medicare & Medicaid Services (CMS) the ability to negotiate directly with companies that make some of the costliest drugs...
The arrival of the Inflation...
02/15/2024
First Report Managed Care
News
Injectable PrEP Overall Acceptable, Preferred for HIV Prevention
07/15/2023
Maria Asimopoulos
“Given overall acceptability, injectable PrEP should be included as part of a menu of prevention options, allowing end-users to select the modality that suits their preferences, needs and lifestyle,” researchers advised.
“Given overall acceptability, injectable PrEP should be included as part of a menu of prevention options, allowing end-users to select the modality that suits their preferences, needs and lifestyle,” researchers advised.
“Given overall acceptability,...
07/15/2023
First Report Managed Care
News
First Gene Therapy for Severe Hemophilia A Is Approved
06/29/2023
This approval comes after a safety and effectiveness trial showed that the treatment improved participants’ annualized bleeding rate after 3 years.
This approval comes after a safety and effectiveness trial showed that the treatment improved participants’ annualized bleeding rate after 3 years.
This approval comes after a...
06/29/2023
Population Health
News
Low Rate of Social Determinants of Health Z Codes in Adults With Hypertension
06/26/2023
Jolynn Tumolo
Researchers examined the presence and use of ICD-10-CM social determinants of health (SDOH)-related Z codes among adults with hypertension and found differences in documentation and medical expenditures.
Researchers examined the presence and use of ICD-10-CM social determinants of health (SDOH)-related Z codes among adults with hypertension and found differences in documentation and medical expenditures.
Researchers examined the...
06/26/2023
First Report Managed Care
News
CDC Data Shows Link Between High Costs and Prescription Nonadherence in Adults
06/21/2023
Julie Gould
In 2021, medication nonadherence among adults was associated with costs, gender, disability status, insurance coverage, and other characteristics.
In 2021, medication nonadherence among adults was associated with costs, gender, disability status, insurance coverage, and other characteristics.
In 2021, medication nonadherence...
06/21/2023
First Report Managed Care
News
Blood Pressure Injections Recalled
05/26/2023
Jolynn Tumolo
Several thousand products containing phenylephrine and norepinephrine were recalled due to a lack of sterility assurance.
Several thousand products containing phenylephrine and norepinephrine were recalled due to a lack of sterility assurance.
Several thousand products...
05/26/2023
Pharmacy Learning Network
News
Astral SteriTech Recalls 5 Injections Manufactured for 4 US Clients
05/26/2023
Jolynn Tumolo
The recalls, designated Class II by the US Food and Drug Administration, impact a variety of antibiotic injections.
The recalls, designated Class II by the US Food and Drug Administration, impact a variety of antibiotic injections.
The recalls, designated Class II...
05/26/2023
Pharmacy Learning Network

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Insights

The Ideal Elective Surgery During a Pandemic
Commentary
The Ideal Elective Surgery During a Pandemic
02/18/2021
This article explains how David Silver, MD, chief of urology and director of the Prostate Center at Maimonides Medical Center, changed his treatment decisions amid the pandemic, and highlights the use of the new CPT code for high intensity...
This article explains how David Silver, MD, chief of urology and director of the Prostate Center at Maimonides Medical Center, changed his treatment decisions amid the pandemic, and highlights the use of the new CPT code for high intensity...
This article explains how David...
02/18/2021
Population Health
Understanding Reimbursement for Doctors Treating SNF Patients Via Telehealth
Podcasts
Understanding Reimbursement for Doctors Treating SNF Patients Via Telehealth
11/04/2020
Paul Knight, OT, MBA, founder and chief product officer, Curatess, discusses the wide variety of telehealth offerings now available for long-term care facilities and explains the reimbursement process for those treating SNF patients via...
Paul Knight, OT, MBA, founder and chief product officer, Curatess, discusses the wide variety of telehealth offerings now available for long-term care facilities and explains the reimbursement process for those treating SNF patients via...
Paul Knight, OT, MBA, founder...
11/04/2020
Annals of Long-Term Care
Improved Reimbursement Options Needed for National Diabetes Prevention Program Providers
Interview
Improved Reimbursement Options Needed for National Diabetes Prevention Program Providers
03/17/2020
Jennifer Torres Mosst, PhD, program manager of Diabetes Strategies at the Division of Chronic Disease and Injury Prevention, explain why billing and reimbursement approaches play a critical role in the types of programs that can be...
Jennifer Torres Mosst, PhD, program manager of Diabetes Strategies at the Division of Chronic Disease and Injury Prevention, explain why billing and reimbursement approaches play a critical role in the types of programs that can be...
Jennifer Torres Mosst, PhD,...
03/17/2020
First Report Managed Care

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Review
Management of Vulvovaginal Disorders in Older Women
04/13/2020
Rohani Manda, MD
Nader Tavakoli, MD, CMD, FAAFP
Richard Stefanacci, DO, MGH, MBA, AGSF, CMD
Nkenna Odom, MD
Stacy Ross, MD
Tiffany Mapp, MD
The objective of this paper is to emphasize the common vulvovaginal problems, other than infections, in older women and their management.
The objective of this paper is to emphasize the common vulvovaginal problems, other than infections, in older women and their management.
The objective of this paper is...
04/13/2020
Annals of Long-Term Care
Feature
Management of Feeding Tube Complications in the Long-Term Care Resident
09/05/2008

Shai Gavi, DO, MPH, Jennifer Hensley, MD, Frank Cervo, MD, Catherine Nicastri, MD, and Suzanne Fields, MD

Shai Gavi, DO, MPH, Jennifer Hensley,...
LTC residents with impaired caloric or fluid intake and a functional gastrointestinal tract may need to receive enteral nutrition through the use of a feeding tube.
LTC residents with impaired caloric or fluid intake and a functional gastrointestinal tract may need to receive enteral nutrition through the use of a feeding tube.
LTC residents with impaired...
09/05/2008
Annals of Long-Term Care
Review
Statin Therapy in the Older Patient: When to Use It, What to Watch For, and When to Stop
10/28/2015

Lisa Byrd, PhD, FNP-BC, GNP-BC1-3

Lisa Byrd, PhD, FNP-BC, GNP-BC1-3 ...
Statin medications are a very powerful group of medications that lower low-density lipoprotein (LDL) levels and are widely used in clinical practice.
Statin medications are a very powerful group of medications that lower low-density lipoprotein (LDL) levels and are widely used in clinical practice.
Statin medications are a very...
10/28/2015
Annals of Long-Term Care
Review
End-of-Life Nutrition: Is Tube Feeding the Solution?
10/17/2013

Liz Friedrich, MPH, RD, CSG, LDN

Series Editor: Liz Friedrich, MPH, RD, CSG, LDN

Liz Friedrich, MPH, RD, CSG, LDN Ser...
One decision regarding nutrition care is whether to use percutaneous endoscopic gastrostomy (PEG) tube feeding in elderly or terminally ill residents.
One decision regarding nutrition care is whether to use percutaneous endoscopic gastrostomy (PEG) tube feeding in elderly or terminally ill residents.
One decision regarding nutrition...
10/17/2013
Annals of Long-Term Care
Get Ready for Consolidation
10/14/2015

Dean Celia

Dean Celia
Big insurers are not the only ones trying to get bigger. Smaller firms, health systems, and others are grabbing for a bigger slice of the pie. Here’s what it means for managed care.
Big insurers are not the only ones trying to get bigger. Smaller firms, health systems, and others are grabbing for a bigger slice of the pie. Here’s what it means for managed care.
Big insurers are not the...
10/14/2015
First Report Managed Care

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