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.
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.
Proposed Payment Systems and Fee Schedules in 2023
Proposed rules revising the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) services, along with new physician fee schedule (PFS) rule sets will significantly impact providers in 2023.
Drug Vial Sizes, Waste and Recovering Costs
Manufacturers have mainly stayed on the periphery of the discussion about how to remedy the issue of unused or wasted drugs from single-use vials, but the REFUND Act is changing that.
