Insurance

Only 6 states across the country are currently receiving funds through the Affordable Care Act (ACA) provision intended to increase Medicaid managed-care payments to meet Medicare payment levels.

Medicare may enjoy the fruits of the growing and varied work among private payers and providers to boost value in healthcare, though the benefits will come sooner to costs than quality, a study suggests.

A new study from The American Journal of Pharmacy Benefits finds that physicians who treat cancer patients may be influenced by the reimbursement policies of the Medicare claim processors that pay them.

Could Medicare payment models impact a physician's decision to prescribe cancer drug supplements? A recent study from The American Journal of Pharmacy Benefits published new findings that say they can.

Facing anticipated reductions in funding and regulatory changes under the health care reform law, several of the nation's largest health insurers have indicated plans to scale back their Medicare Advantage programs.

The healthcare reform act intends to extend insurance coverage for millions of Medicare patients nationwide, but that doesn't mean it will expand their access to physicians.

Medicare accountable care organizations outnumber non-Medicare ACO contracts and make up more than half of the 488 ACOs nationwide, according to an August 2013 update from Leavitt Partners, a healthcare consultancy that follows ACO development.

The federal sequester trims Medicare payments for cancer patients receiving chemotherapy in doctors' offices in an effort to save the government money. Instead, it will end up costing more in the long run, according to the president of the American Society of Clinical Oncology (ASCO).

Critics say a Medicare loophole leaves patients on the hook for tens of thousands of dollars.

Farzad Mostashari, MD, ScM, National Coordinator for Health Information Technology, US Department of Health and Human Services, says that meaningful use sets a foundation for new models to deliver care to an entire population.

Preventive health services are key to ensuring people seek care before their conditions are critical or urgent in nature. As healthcare services for Medicaid and Medicare beneficiaries expand under the Affordable Care Act, so will the need for professionals who can administer certain preventive measures.

A new analysis from HealthPocket of Medicare drug plans reveals that in both traditional Medicare and Medicare Advantage plans, consumers face various hurdles in accessing their medications.

In an effort to offset cost increases associated with the Affordable Care Act (ACA), the Obama administration intends to expand hospitals' access of the 340B discount drug plan. While the expansion may sound promising to some, many others worry that the program will threaten the quality of care, as increased participation risks higher potential for abuse. Even worse, the 340B program will likely rise the cost of cancer care.

Recovery Audit Contractors (RAC) out to identify improper payments made on claims for Medicare beneficiaries

The Centers for Medicare & Medicaid Services Innovation Center held an Open Door Forum on Aug. 1 to announce some modifications to the application for the Comprehensive ESRD Initiative, or renal-specific Accountable Care Organization demonstration.

Medicare will levy $227 million in fines against hospitals in every state but one for the second round of the government's campaign to reduce the number of patients readmitted within a month, according to federal records released Friday.

On July 8, 2012, the Centers for Medicare & Medicaid Services (CMS) released two major Medicare proposed rules impacting payment for physician and hospital outpatient services in 2014. ASH will submit comments to CMS on the proposed rules by the September 6 deadline and would like to incorporate feedback from the Society's practice-based members.

The Obama administration says the average monthly premium for Medicare prescription drug plans will inch up by $1 next year, to $31.

Washington state won't pay for medical procedures that are unsafe, unproven or cost too much. Why can't Medicare do that?

A Centers for Medicare & Medicaid Services (CMS) proposal would cut providers' reimbursement for dialysis treatment by 9.4%, or approximately $1 billion, nationwide.

Physician groups voiced general support for a bill approved Tuesday by a Congressional subcommittee to replace Medicare's sustainable growth rate (SGR) formula.

Medicare is accelerating plans to peg a portion of doctors' pay to the quality of their care. The changes would affect nearly 500,000 physicians working in groups.

The authors present a brief summary of the types of payment arrangements that early accountable care organizations are adopting.

This segment of the panel discussion takes a closer look at the episode of cost for a patient going to a hospital versus a private office setting. Panelists agree that the cost of hospital care is not that much greater than in the office.

Dr. Chernew asks the panelists how payers address the value of these costly combination therapies when there are less expensive options available. Dr. Newcomer says that the drugs being discussed are, in fact, having a significant clinical effect.

First year results are in - all 32 participants in the Pioneer Accountable Care Organization (ACO) initiative showed success in improving quality. However, not as much success was made in cost savings.

Medicare beneficiaries with diabetes who are at the lowest levels of healthcare consumption often become some of the highest level consumers in subsequent years.

Many physicians who treat Medicare patients may see an end to unreimbursed evaluation-and-management (E&M)