Analysis: New HELP draft surprise-bill legislation bases payments on geographic median rate
Recent changes to the HELP draft surprise-bill legislation indicate there is unity in Congress around calculating payments to providers for out-of-network services, but challenges to the geographic-median approach are on the horizon.
ZDoggMD: How to get to healthcare 3.0
Motivational healthcare speaker urges changes to encourage and allow providers to engage emotionally with patients and drive real change.
3 details for healthcare providers to know before taking on risk
Providers looking to take on downside ACO risk need to first understand three determinants of success.
Forecast: ACA tug-of-war to continue through 2020
Given the political realities of a divided government, the forecast through 2020 calls for a continuation of the tug-of- war over the Affordable Care Act (ACA) in Washington. With the ongoing expansion of the field of Democratic Party contenders for the presidency in 2020, not to mention the continuing battle over the ACA between the…
Little progress seen in mitigating prior-authorization challenges
Prior-authorization challenges appear to be worsening for providers, despite a 2018 payer-provider effort to address such problems.
What’s the blueprint for taking on risk?
Providers and health plans need to collaborate — both in the planning and execution of risk-based contracts — in order to make them work.
Providers press CMS for details amid lingering uncertainty about new primary care models
The possibility of conflicts between Medicare payment models joined the customary concern about benchmarking details in provider feedback on coming primary care models, an administration official said.
Analysis: Effect of expansion of pre-tax accounts for employees to purchase insurance
HFMA's Chad Mulvany shares the possible impact of a proposed rule that allows employers to make pre-tax contributions for employees to purchase individual coverage starting in 2020.
CMS identifies keys to success in bundled payment as BPCI-A deadline looms
Ahead of next week’s deadline for providers to join the largest voluntary bundled payment program, the agency in charge of the program identified lessons learned from successful participants.
Analysis: Price check in the EHR
Humana may be a more desirable partner for physicians interested in risk arrangements if its collaboration with Epic reduces potentially preventable ED and inpatient utilization due to increased medication adherence.