Insurance

Despite the considerable resources designated to PCORI, its future remains tenuous.

The CMS intends increase Medicare payments to hospices and also make several tweaks to policy definitions and procedures to ensure more accurate reimbursement.

The Centers for Medicare & Medicaid Services (CMS) proposed a rule this week that would reduce payments for hospital readmissions and hospital-acquired conditions in 2015.

The Centers for Medicare & Medicaid Services late Wednesday issued a proposed rule for 2015 that reduces payment for readmissions and hospital-acquired conditions, but provides no changes to the controversial two-midnight rule.

An advisory panel to the CMS voted against recommending an annual low-dose CT scan for high-risk individuals citing no benefit over the harm of false-positives.

Keith Dunleavy, MD, president, CEO, and chairman of the board for Inovalon, Inc, says that healthcare is enormously complex, and that it's being driven across a broad range of audiences.

Left as-is, current exchange formuarly and network search technology has the potential for a lot of consumer dissatisfaction and backlash.

The American Journal of Managed Care publishes a first-of-its-kind study comparing different types of health insurance plans and different levels of co-payment, to see how varieties of coverage affect access to therapeutic drug classes.

Look beyond the EHR incentive program. A national effort to turn CMS's recent release of Medicare physician payment data into useful, actionable data visualizations is the hottest HIT challenge right now.

Leaders from the Centers for Medicare & Medicaid Services think private insurers have been too slow to adopt payment reforms, but they would be best served by adopting value-based payment systems in tandem with CMS today.

The Obama administration's top Medicare official is stepping down from his post. CMS Principal Deputy Administrator Jonathan Blum has been with the agency for more than five years.

The proportion of available on-patent drugs covered in low copay tiers varied by insurance type, with the lowest proportion being in Medicare plans.

A US Department of Health and Human Services (HHS) analysis determined that a new payment formula, which would reduce Medicaid reimbursement rates for generic prescription drugs, could save Medicaid up to $1.2 billion per year. So why are pharmacists and drug manufacturers pushing back?

Two new studies in The American Journal of Managed Care find that state Medicaid restrictions on access to newer antipsychotic drugs save little in the short run, and may cost more later when patients fail to stay on their medication, end up in the hospital, or both.