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Reimbursement

A mature male physician shouting through a megaphone in front of a U.S. $5 and $10 dollar bills.

Virginia Docs Get Just $15 for Certain Medicaid ED Visits

Budget item determines 800 diagnoses, including asthma attacks, are "avoidable" emergency visits

AAFP over a photo of a male physician making a protective gesture around a family icon.

Q&A: Sterling Ransone, Jr., President of the American Academy of Family Physicians

Better pay and fewer paperwork hassles for members are high priorities for AAFP's new president

A young male physician holds up his resume.

More Physicians Are Now Employees Rather Than Owners

Here's what's behind the continued decline of independent practice

Six U.S. $100 bills and a stethoscope protrude from the breast pocket of a doctor鈥檚 coat.

Medicaid Will Be a Bigger Target for Alternative Payment Models, CMS Official Says

Health equity also will be a focus, says CMMI official Ellen Lukens

Packaging of Lucentis (Ranibizumab) 10 mg/nl solution injectable

Doc Admits to Using Misbranded Eye Medication on Patients

James Heroman, MD, also falsely billed Medicare to make a profit, DOJ alleged

A female physician discusses a hip replacement with her senior female patient.

Medicare Is Sticking With Mandatory Demonstration Models for Now

But "we need to move away from having a model for every episode," says CMMI head Elizabeth Fowler

1091 printed on a red rounded rectangle laying on envelopes of varying colors

Are Doctors Drowning in Inbox Overload?

The slow simmer of non-stop messaging boils over during the pandemic

Explanation of benefits paperwork.

Doc Groups Hail Decision to Delay 'Advanced EOB' Rule

Regulation set to start on January 1, but administration says it will "defer enforcement"

A photo of radiotherapy equipment

Medicare's Radiation Oncology Payment Model Vexes Oncology Community

Participation required for certain radiation oncology practices starting next January

Prime Healthcare Settles Kickback Claims

The California health system will pay over $30 million

Several packets of Suboxone sublingual film

As Overdoses Rise, Opioid Treatment Providers Struggle to Get Paid

Providers of medication assisted treatment say they're bleeding cash, and unable to keep staff

AMA over a grid of doctors faces of various genders and ethnicities.

Medical Residents Need Better Working Conditions, AMA Delegates Say

More access needed to healthy food, child care

A photo of Donald Berwick, MD

Want Healthcare for All? Ditch Fee-for-Service, Says Former CMS Chief

"We should move to global budgets as soon as possible," says Donald Berwick

A photo of the CMS headquarters building in Baltimore, MD.

New Rules for Some Medicare ACOs Are No Good, Say Healthcare Groups

Letter seeks a 3-year delay for reporting new quality measures

Hands tossing protective masks into a blue sky

After the Pandemic: How Will Medical Practices Fare?

Telehealth's role will depend on reimbursement, says MGMA's Anders Gilberg

A computer rendering of a highway with years printed on it stretching out to the horizon beginning with 2021

On the Road to High-Value Healthcare in the U.S.: Are We There Yet?

CMS needs to keep the value-based payment models that work, and ditch the others

A checkmark and X in circles over an x-ray image of spinal fusion.

Doc Groups Object to New Prior Authorization Rules in Medicare

Requirements for two spinal procedures set to take effect July 1

Anesthesiology Group Squeezed 'Like a Boa Constrictor' Sues Insurer

U.S. Anesthesia Partners alleges UnitedHealthcare is blocking competition

A photo of the exterior of St. Louis Heart and Vascular

Stripped of Hospital Privileges, St. Louis Cardiologists Go to Court

Suit against SSM Health seeks $50 million if former status not restored

Cardiologist Coughs Up $2M for Unnecessary Procedures

Dinesh Shah, MD, allegedly billed for tests that were unnecessary or never done

ISC over a computer rendering of a male figure with the front of his brain highlighted by a flash of light

Multi-City Study Bolsters Case for Mobile Stroke Units

But reimbursement woes, balkanized EMS agencies block path to broader use

A Medicare Advantage infographic with the word FRAUD added to it in red

Op-Ed: Fraud Is Rampant in Medicare Advantage

Enforcing the False Claims Act can help

A photo of Feng Qin, MD

Vascular Surgeon Admits Doing Unnecessary Procedures

Feng Qin, MD, will pay $800,000 and be excluded from Medicare for 4 years

Photo of Iora Health co-founder Rushika Fernandopulle, MD (Photo courtesy Iora Health)

Healthcare Disruptors: Doubling Down on Primary Care

Iora Health and its care teams are changing the way primary care is delivered

An x-ray image of a person鈥檚 chest showing a retained pacemaker wire

Abandoned Cardiac Device Leads More MRI-Friendly Than Previously Thought

Safety of scans supported by observational study

Photos of Amir Kaki, MD, and Mahir Elder, MD

Detroit Cardiologists Awarded Millions for Retaliation Claim

Judge dismisses Tenet's bid to vacate arbitrator's ruling

A photo of President Donald Trump signs an executive order in the Oval office

Medicare's 'Most Favored Nation' Drug-Pricing Rule in Limbo

Rule affecting Part B drugs was to take effect Jan. 1 but was stopped by federal court orders

A photo of Moses deGraft-Johnson, MD, over $100 bills falling

Vascular Surgeon Pleads Guilty in Blood Vessel Scam

Physician performed unnecessary procedures and faked thousands of insurance claims, feds say

2021 Medicare Fee Schedule Includes 10.2% Cut in Conversion Factor

Cognitive specialties will see increases while radiologists, pathologists get pay cuts

INVESTIGATIVE ROUNDUP over an image of two people looking at computer screens.

Doc Gets 5 Years for Fraud; Vaccine-Hesitant Docs & Nurses; Lysol Under the Lid

This past week in healthcare investigations

An ADD CARD credit card pop up window over a screenshot of the Practice Fusion software

Some Docs Will Pay Separately to Use CPT Codes Next Year

AMA licensing fee won't be included in Practice Fusion EMR in 2021

Interior of an empty courtroom with a gavel and sounding block on the desk

NY Emergency Docs Sue Insurer for Not Paying Enough

Out-of-network physicians charge UnitedHealth conspired to reimburse them at lower rates

A male physician holds an envelope with several $100 bills sticking out from it

Sunshine Act Brings Some Transparency but Little Change

Industry largesse to physicians unaffected; strong link between payments and choice of ICDs

Maintenance of Certification at Issue in Appeals Court Hearing

Critics fight to dump MOC

A mature woman reacts with concern at mail she has just opened by the mailbox

Surprise Billing Seen Likely for Many Colonoscopies

And would be illegal for uncomplicated procedures

A close up of two hands exchanging a set of keys

Op-Ed: How to Sell Your Practice to Private Equity

Attorney offers 12 tips on getting the best deal

An illustration of a hand holding mobile phone with app for healthcare

Telemedicine Takedown; Cue the Copays; Winners for Satisfaction

Emerging trends in telemedicine and telehealth

A mature couple enjoys champagne aboard a private jet

These Forbes 400 Billionaires Made Their Fortunes in Healthcare

14 individuals, $66 billion in combined net worth

Florida Surgeon Tries Again With Whistleblower Suit Against Hospital

Seeks damages after dismissal, allegedly for refusing to keep all referrals in-network

Elderly senior woman, having a remote medical consultation with her doctor over internet

Is Telemedicine the Future of Palliative Care?

Proponents say it will increase access and foster rapport, but sustained uptake likely hinges on reimbursement

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