Proposed Spending for 2025 and 2026
WHAT’S PROPOSED for the 2026 payment year for Medicare Parts A and B? And, what other issues will impact the rest of 2025 and extending into 2026?
Payment for Medications: It’s an Exacting Team Sport!
Getting paid for drugs demands a robust chain of events linking product procurement, its use within both the clinical framework and payer requirements, and the revenue cycle function of charging, billing and subsequent reimbursement.
Drug Reimbursement: Working with Payers
Drug reimbursement hinges on a variety of issues. Here are the top five to consider.
Overcoming Challenges of Delivering Quality Healthcare
Several healthcare associations have identified many challenges of delivering quality healthcare and are working toward implementing solutions.
Using Modifiers to Untangle Billing for Waste
Even with the coding sets used to reimbursement healthcare expenses, it is sometimes necessary to increase the specificity of the data or to add a contingency of payment by adding modifiers.
First Drugs Selected for Medicare Drug Price Negotiation
The U.S. Department of Health and Human Services announced the first 10 drugs covered under Medicare Part D selected for negotiation as part of the Inflation Reduction Act.
2024 OPPS, ASC and PFS Proposed Payments
The proposed calendar year 2024 Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center (ASC) and Physician Fee Schedule (PFS) payment rule sets are being finalized to begin Jan. 1, 2024.
Tips for Operating on Razor-Thin Margins
Healthcare providers across the national have marked well more than a year of consecutive negative margins as they experience the effects of higher expenses.
Potential Disruptors: 2023 and Beyond
Financial Challenges remain a consisten t and growing concern for the healthcare industry, so taking actionable steps to produce tangible results can assist the industry in righting itself after uncertain times of financial instability.
The Inflation Reduction Act: A Radically Different Market Environment
The 2022 Inflation Reduction Act significantly changes the U.S. prescription drug pricing regulations, creating a radically different market environment.
