Healthcare ECONOMIST

MARCH 8, 2024

A formulary is a continually updated list of medications, products, and technologies supported by current evidence-based medicine, as well as the judgment of physicians, pharmacists, and other relevant experts in the diagnosis and treatment of disease and preservation of health. Below is a quick overview. What is a formulary?

Accountability 92

Accountability Pharmaceuticals 92

HIT Consultant

MARCH 17, 2024

These new entrants are largely focused on offering primary care, urgent care, and a growing list of specialty services to make care more easily accessible, affordable, and cost-transparent. By working together with authentic data, both payers and retail health centers have a unique opportunity to significantly impact patient care.

Healthcare 109

Healthcare Urgent Care Primary Care Patient Experience 109

HIT Consultant

APRIL 9, 2024

To address the benefit needs of underrepresented population groups, payers can develop “more equitable approaches to healthcare benefits design that recognize and meaningfully address access and affordability concerns,” according to a 2022 article in the American Journal of Health Promotion. And the list goes on.

Population Health 90

Population Health Healthcare Analytics Health Data Primary Care 90

Healthcare ECONOMIST

MARCH 26, 2024

In the Figure below, spending growth is decomposed into prices and volume, where Panel A looks at consumption deflators for public payers and panel B looks at consumption deflators for private payers. out-of-pocket costs or private insurance). The full paper can be read here.

Medicaid 99

Medicaid Medicare Healthcare 99

HIT Consultant

APRIL 26, 2024

This comprehensive care model empowers payers to better manage specialty drug costs. Wide Range of Medications: Access to a growing list of 240 limited distribution drugs, including exclusive options and medications in narrow networks. We have the flexibility to contract dynamically with any payer.

Pharmaceuticals 66

Pharmaceuticals Patient Experience Nursing Integration 66

Healthcare It News

OCTOBER 4, 2022

CMS has provided payers with the option to implement a framework to show that they are connecting to HL7 FHIR APIs. Stakeholders who attain CARIN Code of Conduct Accreditation will be listed on the CARIN My Health Application site and the EHNAC Accredited Companies page.

Regulations 262

Regulations Medicaid Medicare Healthcare 262

Healthcare ECONOMIST

MARCH 11, 2024

Payers make decisions for patients since–in most developed countries–third-party payment cover most of the cost. The PREFER methodology lists different types of methods from Soekhai et al. However, third parties often make decisions for patients. Physicians make decisions for patients due to asymmetric information (i.e.,

98

98

Healthcare It News

JULY 21, 2022

He said the deal represents an opportunity to help build a primary care experience with Amazon that's "more accessible, affordable, and even enjoyable for patients, providers, and payers." going forward.

Primary Care 294

Primary Care Healthcare Doctors 294

Home Health Care

FEBRUARY 16, 2024

In general, the home health consulting firm SimiTree has noticed an increase in the amount of providers that have been struggling with things like unbilled claims, inaccurate primary payer selection and more, according to Lynn Labarta, vice president of post-acute revenue cycle management at SimiTree. We see this constantly.”

Home Care 100

Home Care Medicare Prevention Nursing 100

Healthcare It News

OCTOBER 13, 2022

Data tools are also high on the list of provider IT needs for FHIR adoption. The Centers for Medicare and Medicaid Services Office of the National Coordinator for Health Information Technology final rule prevents information blocking and promotes competition and innovation in healthcare IT.

Healthcare 262

Healthcare Integration Health Data Patient Experience 262

Health Populi

FEBRUARY 13, 2024

Reviewing that list, starting with the great Dr. Tom Ferguson, one of Susannah’s mentors and many of our early role models working in what we then called eHealth, was a sweet d éjà vu. Here’s an initial list of Susannah’s Rebel Health book tour from the Penguin Random House site — keep checking it out for updates.

Doctors 160

Doctors Health Data Life Sciences Hospitals 160

Home Health Care

JANUARY 3, 2024

The company plans to be listed on the Nasdaq, with the stock ticker BTSG. NYSE: JEF), Morgan Stanley (NYSE: MS) and Bank of America (NYSE: BAC), among others, acted as underwriters for the listing. KKR and an affiliate of Walgreens Boots Alliance (Nasdaq: WBA) acquired BrightSpring for $1.32 billion in 2019.

Rehabilitation 67

Rehabilitation Primary Care Medicare Home Care 67

Sheppard Health Law

JANUARY 26, 2024

The payers impacted by the Final Rule include Medicare Advantage (“MA”) organizations, state Medicaid and Children’s Health Insurance Program (“CHIP”) agencies, Medicaid and CHIP managed care plans, and plans on the Affordable Care Act exchanges (collectively, “Impacted Payers”).

Medicare 52

Medicare Medicaid Hospitals Health Data 52

Home Health Care

JULY 20, 2023

As part of its business model, DocGo works with governments, health systems and payers. Under the partnership, HealthCare Partners NY will give DocGo a list of individual members that are non-compliant with these types of measures. Moving forward, DocGo plans to work with payers in a similar capacity.

Healthcare 74

Healthcare Primary Care Doctors Medicaid 74

p3care

SEPTEMBER 17, 2021

Medical billing software has been a blessing so far as it truly automates the way physicians interact with patients and payers (government or private). Here is a list of parameters that the RCM solution must be able to do. Such systems are fully automated to send notifications to patients and payers when required.

Accountability 245

Accountability Doctors Healthcare Hospitals 245

Etactics

MARCH 13, 2024

Fast forward to 100 years in the future, during the 1930’s the system evolved into the International List of Causes of Death. This allows payers to decide how a person will handle their payment responsibilities. For example, payers can determine which plan has the primary payment responsibility and how the other plans can contribute.

Regulations 52

Regulations Accountability Doctors Medicare 52

Briggs Healthcare

APRIL 4, 2022

The pre-rulemaking process requires that HHS make publicly available, not later than December 1 annually, a list of quality and efficiency measures HHS is considering adopting, through the federal rulemaking process, for use in the Medicare program.

Medicare 97

Medicare Accountability Medicaid Healthcare 97

Healthcare ECONOMIST

MAY 11, 2023

You can list to the episode here (the segment on breast cancer screening starts at 5:32 ). Jason Shafrin on Marketplace Morning Report, May 11, 2023 I also weigh in on the provider impact as screening is often not well-reimbursed Costs are rising and reimbursement may be lagging especially for the public payers, Medicare and Medicaid.

Healthcare 64

Healthcare Medicaid Medicare 64

Healthcare It News

MAY 5, 2022

So, real-time tracking of key indicators can help turn the corner, and communication between the provider, the patient and the payer team could make chronic care management work. Most are lab tests, but they are not assembled in a list for that specific disease. The payer part is an interesting sideline.

Hospitals 213

Hospitals Home Care Healthcare 213

NASHP

APRIL 5, 2022

The tool also shows how those costs relate to both the hospital charges (list prices) and the actual prices paid by health plans. NASHP’s interactive Hospital Cost Tool provides anyone from policymakers to researchers with insights into how much hospitals spend on patient care services.

Hospitals 133

Hospitals Medicare Medicaid 133

Health Populi

JULY 24, 2023

Here’s a list of the four categories of medicines on the GNC PRO “free formulary,” as it were. ” The quid pro quo value exchange is that GNC ramps up its membership list of consumers for the program and the promise of other purchases from the virtual or brick-and-mortar “front of the store.”

Urgent Care 118

Urgent Care Healthcare Primary Care Quality of Care 118

p3care

JUNE 21, 2023

To facilitate accurate billing and coding, the CMS offers a list of covered chiropractic codes. By doing so, chiropractic billing services can avoid claim denials and delays in reimbursement. Use of Chiropractic Modifiers Modifiers provide additional information about the chiropractic services rendered.

Medicare 130

Medicare Prevention Healthcare Providers Healthcare 130

HIT Consultant

JULY 19, 2022

Jessica Bonham-Werling, Payer and Provider Solutions Marketing at Redox. America’s Health Insurance Plans (AHIP) recently assembled a truly impressive list of what health plans across the nation are doing. What my 3-year-old might call “a long, long, long, long time”. So in the meantime, what can be done?

Healthcare 98

Healthcare Healthcare Improvement 98

Healthcare ECONOMIST

FEBRUARY 8, 2024

Understanding the economic impacts on patients and caregivers can help payers and other decision-makers to better design plans and strategies to ultimately improve patients’ experiences and outcomes. Economic Impacts. Scientific Spillover. IVI and AcademyHealth Economic Impacts Framework.

Patient Experience 88

Patient Experience Healthcare 88

Etactics

NOVEMBER 3, 2022

Billing isn’t as simple as submitting a claim to a patient’s insurance payer, the payer reviewing the document, and you gett paid. Healthcare organizations use these documents for reimbursement from insurance companies (aka payers). These types of diagnoses come about as your treat the primary diagnosis listed in the header.

Healthcare Providers 52

Healthcare Providers Prevention Healthcare Accountability 52

HIT Consultant

MARCH 16, 2023

Jim Collins, President of Medicare MSO Physicians need to keep their billing and coding right to ensure seamless reimbursements from payers. In addition, these codes help providers submit claims to payers and get paid for services. Similarly, there are additions in the list of telehealth services offered to patients.

Medical Practitioners 97

Medical Practitioners Medicare Nursing Hospitals 97

Home Health Care

JANUARY 2, 2024

It’s one of the many payers that has prioritized home-based care as well. Devoted Health was also named to Fortune’s Best Workplaces in Health Care list and its Best Workplaces for Women list. Devoted, founded in 2017 by brothers Todd and Ed Park, was one of the first organizations to popularize the term “payvidor.”

Medicare 62

Medicare Home Care Primary Care Quality of Care 62

Lexis Nexis

JULY 26, 2023

Enrollment fraud remains a major challenge for payers. So payers need a data analytics partner with the tools and expertise to stop bad actors in their tracks. They can help you set up early alerts and make dishonest enrollees stand out so it’s easier to root them out of your new member lists. It’s an unfortunate reality.

Prevention 52

Prevention Doctors Health Data Healthcare 52

Home Health Care

MARCH 1, 2023

Referral sources] don’t want someone that just wants their fee-for-service [business] — they want to see a list,” she said. And then we get that to our payer innovation team, so that they can start further developing that pipeline.” They want to know that you really can be a more full-service provider.”

Medicare 85

Medicare Hospitals Healthcare 85

Home Health Care

SEPTEMBER 29, 2022

Two groups of stakeholders that home-based care providers need to win over in the near-term future are payer leaders and policymakers. In a world where the value of care is taking precedence over the volume of care, it’s important to show payers that home-based care is cost-effective and improves outcomes. “In Period” Korte said.

Regulations 88

Regulations Patient Safety Hospitals Home Care 88

HIT Consultant

NOVEMBER 15, 2022

Payers, including insurance companies and government agencies, cannot help but look at the bottom line. Equipped with that knowledge, payers, pharma companies, and caregivers can better allocate their resources. Yes, the purpose of medical research is to save lives and improve the quality of life. But at what price?

Hospitals 98

Hospitals Medicare Prevention Healthcare 98

Home Health Care

FEBRUARY 15, 2023

There are multiple hurdles to overcome for the company, which has been publicly listed for less than eight months. Those changes included the additions of a chief human resources officer and a “payer innovation team.” All the while, the payer innovation team is working hard at Enhabit to get more – and better – contracts with MA plans.

Medicare 102

Medicare Accountability Nursing 102

Icanotes

APRIL 13, 2021

It then reviews the claims before forwarding them to the payer, which is usually an insurance company. A payer can reject a claim if the codes aren't accurate, which can delay payment. Confirms compatibility: The clearinghouse verifies that the provider's claim is compatible with the payer's software, as well.

Accountability 59

Accountability Healthcare Providers Quality of Care Regulations 59

Sheppard Health Law

DECEMBER 15, 2022

The Proposed Rule, among other proposals, provides for new rules and standards for a payer-to-payer data exchange. In this post, we focus on the potential impact on MAOs of 1) the payer-to-payer data exchange and 2) prior authorization requirements. Payer-to-Payer Data Exchange Requirements.

Medicaid 52

Medicaid Medicare Prevention Healthcare 52

Home Health Care

MAY 4, 2022

Aetna – one of the largest health insurance payers in the U.S. – That included the launching of “all-payer health products and services” to diversify the company’s growth portfolio and, more importantly, an “expansion of home health services.”. “But That] would make a lot of sense and they’d be high on the list.”.

Primary Care 114

Primary Care Medicare Care Transition Home Care 114

Home Health Care

SEPTEMBER 21, 2023

This means diligence request lists, requests for information, management meetings, diligence calls and data rooms. Billing and coding claims reviews are conducted to make sure that the billing and coding that’s been done in the past is compliant with laws and payer requirements. “We The process becomes more formal.

Law Firms 79

Law Firms Home Care Medicare Integration 79

Etactics

SEPTEMBER 28, 2022

An exact duplicate means that the payer determined that the same claim was already submitted in terms of… Date of service (DOS) Type of Service Provider number Procedure code of CPT Place of service (POS) Billed amount. Sometimes the payer has correctly identified that the claim is a duplicate of one already sent in. via Change.

Hospitals 52

Hospitals Healthcare Medicare 52