Impacts of IRA’s 3rd Release: Drug Pricing in a Radically Different Market!
The impacts of IRA’s negotiating results are being seen in 2026 with more results to come in 2027 and beyond.
Sustainability: Balancing Spend with Revenue to Support Outcomes
Affordability and cost-containment pressures are top of mind in all healthcare systems, coupled with uncertainty as to which rapidly proposed/announced changes in pricing models, among others, will be implemented.
Payment in 2026 Necessitates Being Proactive
Finding leaks in healthcare revenue is more important than ever. Here’s where you can find some meaningful remedies for 2026.
2026 Proposed Payments: Outpatient Settings and Physician Offices
With several pieces of legislation being debated that will significantly impact practices’ revenue streams, operations and clinical services, strategic negotiating is more important than ever.
Payment Complexity Demands Data Integrity
Healthcare payments are complex. Consider implementing these strategies to help manage your organization’s payment policies and workflows.
Understanding Drugs and Money in 2025
Specialty medications are an integral part of the first approach to treatment in an ever-increasing number of disease states, but costs have ballooned to an astronomical number.
CMS Proposed Payment Rules for 2025
In addition to payment rate changes, 2025’s proposed rules include policies focused on health disparities, behavioral health access, improved transparency and better patient-centered care.
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.
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.