Reimbursement

Rising premiums and reduced choice among insurance options are two challenges facing health insurance purchasers under the Affordable Care Act in 2019; nonetheless, public support for the act continues to be strong enough to block efforts to repeal the act.

Oct. 26—Hospitals would face uncertain financial impacts under a Medicare drug payment pilot announced this week.

Providers should restructure pricing schedules to bring charges into better alignment with the actual cost of services, developing a long-term pricing model that is attractive to both patients and employers.

Oct. 25—Next week’s start of open enrollment for the individual health insurance marketplaces comes as the Trump administration moves forward with an overhaul.

Jim Wieland discusses the steps a practice took, and the lessons it learned, as it formed the nation’s first cardiology accountable care organization.

Oct. 24—The outlook among for-profit hospitals remains stable over the coming 18 months, according to Moody’s Investors Service.

Oct. 23—A so-called mega rule to overhaul federal standards for Medicaid health plans could come days after the midterm election, an industry leader said this week.

Hospitals can choose to post charges in a variety of ways, but not all methods comply with CMS’s recent rule that takes effect on Jan. 1, 2019. 

Karin Chernoff Kaplan reviews the basics—and the importance—of establishing consistent processes for setting up and managing physician compensation agreements and thresholds that avoid regulatory problems.

Oct. 16—Additional state expansions of Medicaid eligibility are among the expected developments coming next year to the program, according to a former federal leader of Medicaid.