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On January 1, 2015, the Centers for Medicare & Medicaid Service (CMS) introduced 4 Healthcare Common Procedure Coding System modifiers, known collectively as the - X(EPSU) modifiers, as a subset of Current Procedural Terminology (CPT) modifier 59 (distinct procedural service).

Innovative care delivery programs intended to improve quality and reduce costs need sustainable business models in order to last beyond the end of grants or other methods of time-limited funding. RAND researchers take a look at methods Massachusetts health plans and accountable care organizations are using.

Taking the time to educate patients before their medical device implantation has positive implications for patients, healthcare providers, and medical device manufacturers, according to a new poll.

An account in The New York Times comes closest to identfying the drafting error that set in motion King v. Burwell, the case that could unravel a key feature of the Affordable Care Act. Meanwhile, experts predict that a ruling for the plaintiffs will create political fallout for more Republicans than Democrats.

Published in the Canadian Medical Association Journal, the study found that the scale can help predict readmission or death within 30 days after hospital discharge among geriatric patients.

The results of an ongoing study, presented at the annual meeting of the Heart Failure Association of the European Society of Cardiology in Seville, Spain, identified a 5-fold increased risk of death in heart failure patients who were depressed.

As more patients become insured under the Affordable Care Act, driving demand for primary care and urgent care services, there is an increased need for alternative service sites, according to an analysis from Alvarez & Marsal.

The Obama Administration says that Florida can receive $1 billion this year and $600 million next year to pay for uncompensated care in safety net hospitals. However, the administration made it clear that more funding awaits the state if Medicaid expansion reaches those up to 138% of the federal poverty line.

German health authorities are debating whether the price of Europe's first approved gene therapy is worth the $1 million price tag.

Consumers with chronic diseases face challenging trade-offs when choosing health coverage, especially when it comes to out-of-pocket drug costs.

The implementation of the Affordable Care Act and its resulting market turbulence has not created the operation challenges for payers that was expected, according to a report from athenahealth, Inc.

Although millions of Americans have gained health insurance under the Affordable Care Act, the Commonwealth Fund recently found that 31 million individuals were underinsured in 2014.

A bipartisan effort reintroduced legislation that would establish a demonstration in Medicare Advantage to evaluate the use of value-based insurance design's ability to reduce copayments and coinsurance for some Medicare Advantage beneficiaries, reported the University of Michigan Center for Value-Based Insurance Design.

This week one top healthcare executive said consumers can expect to pay more for healthcare in 2016, the American Urological Association's annual meeting reports on fallout from the US Preventive Services Task Force's controversial prostate cancer screening recommendation, and more.

Encouraging results with a shorter course of hepatitis C treatment were presented at the Digestive Disease Week meeting. Patients receiving an 8-week course of sofosbuvir and daclatasvir, previously naïve to direct-acting antiviral treatment, achieved a sustained response at 12 weeks.

Authors led by Harvard's Frank Hu, MD, write that combating diabetes worldwide requires policy solutions that recognize the societal and environmental forces that work against those who might try to pursue healthier lifestyles. Hu recently spoke at Patient-Centered Diabetes Care 2015, presented by The American Journal of Managed Care and Joslin Diabetes Center.

The 21st Century Cures bill is a bipartisan initiative that is aimed to streamline and hasten the drug and device approval process and promote medical innovation.

While there's been controversy around the drug discount program for some time, the Health Resources and Services Administration plans to release a "mega-guidance" that will address several aspects of the 340B program.

To improve accountability in healthcare, physicians are continually tasked with checklists to ensure quality. But where is that leading to?

The authors discuss the success of the Pioneer ACO model and the Comprehensive Primary Care Initiative, among others. They outline an agenda that includes engaging managed care stakeholders, so that both public and private payers are moving toward value-based payment.

A study published in Nature Medicine highlights how genetic data can be translated in disease prevention and evidence-based clinical management.

Karen Ignagni is stepping down as president and chief executive officer of America's Health Insurance Plans for a position with EmblemHealth in New York.

Although the new and more effective hepatitis C drugs are expensive, they could save the United States and 5 European countries more than $3.2 billion annually, according to estimates reported at Digestive Disease Week 2015.

ASCO says that it's Patient-Centered Oncology Payment model meets the criteria for an Alternative Payment Model as defined by Congress in the Medicare Access and CHIP Reauthorization Act of 2015, which replaced the Sustainable Growth Rate formula.

Another 1.1 million individuals could potentially be affected by another cyberattack. CareFirst BlueCross BlueShield announced that it had been the target of a sophisticated cyberattack. The hackers gained access to a single database in June 2014, according to the company.

The most sweeping overhaul of Medicaid regulations since 2002 is due soon. So far there are few hints at what CMS may require states to do as they award managed care contracts in an effort to better coordinate care and control costs.

The article, published in the Journal of Hospital Medicine, found that large urban hospitals that serve as a safety net for patients with lower socioeconomic status, are at a disadvantage due to factors outside of their control.

Researchers at Cancer Research UK have challenged the current standard of care in advanced ovarian cancer patients. Results of their study, published in Lancet, found that administering chemotherapy prior to surgery can have huge benefits on health outcomes and the patient's quality of life.

Intelligent Engagement, through the use of virtual health assistants in conjunction with a variety of adherence technologies hold the promise to create an overall strategy for an intelligent adherence plecosystem.

With studies showing that patients overestimate the benefits of cancer screening and are misinformed about the potential harms, the American College of Physicians has issues advice for screening adults with average risk and no symptoms for 5 common cancers: breast, colorectal, ovarian, prostate, and cervical.