(Reuters) – The U.S. Department of Justice (DOJ) has joined a whistleblower lawsuit against UnitedHealth Group Inc. that claims the country’s largest health insurer and its units and affiliates overcharged Medicare hundreds of millions of dollars, a law firm representing the whistleblower said on Thursday. “We reject these more than five-year-old claims and will contest…
What Our Colleagues Should Know: Integrated Care for the Lungs
Multi-system diseases have unique challenges. And Dr. Aryeh Fischer says that when treating patients with interstitial lung disease, pulmonologists and rheumatologists must better understand “how we [both] approach our shared diseases.”
Quality Update Reporting Changes under MACRA
With the termination of the Sustainable Growth Rate formula through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), clinicians who participate in Medicare Part B will now be reimbursed through a new payment model called the Quality Payment Program (QPP). How It Works The QPP rewards the delivery of high-quality patient care via…
ACR Urges CMMI to Test Transparently: Coalition offers principles to guide CMS’s care innovation efforts
The Center for Medicare and Medicaid Innovation (CMMI), which develops concepts for healthcare payment and service delivery, must be transparent and engaged with all stakeholders as it tests new models, according to a coalition of 30 associations. On Feb. 10, the Healthcare Leaders for Accountable Innovation in Medicare Coalition, which includes the ACR, released six…
RISE Is Ready for MIPS
Implementation of the Medicare Access and Chip Reauthorization Act of 2015 (MACRA) began Jan. 1. What does this mean for rheumatologists? It means you must pick the measures by which you will be evaluated and the pace at which you will begin reporting in the Merit-Based Incentive Payment System or participating in an Advanced Alternative…
Diagnosed by Artificial Intelligence?
“To err is human.” —Alexander Pope (1688–1744) The Wisest Minds in Medicine At some point during our careers, we have the privilege of meeting a physician so talented that everyone else pales in comparison. These are those gifted clinicians whose astonishing mastery of medicine makes everyone in their midst feel like inept, babbling fools. They…
U.S. Healthcare Costs to Escalate Over Next Decade
WASHINGTON—The cost of medical care in the United States is expected to grow at a faster clip over the next decade and overall health spending growth will outpace that of the gross domestic product, a U.S. government health agency said on Wednesday. A report by the U.S. Centers for Medicare and Medicaid Services (CMS) cited…
Trump Administration Proposes Stricter Obamacare Rules
NEW YORK—The Trump administration on Wednesday proposed changes to the Obamacare individual insurance market that insurers welcomed as a good start but that others pointed out could raise out-of-pocket cost for consumers. President Donald Trump and congressional Republicans have promised to scrap the 2010 healthcare law that is a key legacy of Democrat Barack Obama’s…
Rheumatologists Can Boost Job Satisfaction with Back-to-Basics Practice Management
Over the past two decades, many physicians have ironically abrogated their intellectual abilities by resigning themselves to a fate of being worthless unless they work for someone else. Many factors have contributed to this process, including, but not limited to, declining reimbursements, escalating costs, onerous electronic record mandates, intense competition from hospital conglomerates and burdensome…
U.S. Court Blocks Anthem-Cigna Deal
(Reuters)—A federal judge on Wednesday ruled against U.S. health insurer Anthem Inc.’s proposed $54 billion merger with smaller rival Cigna Corp, derailing an unprecedented effort to consolidate the country’s health insurance industry. The U.S. Department of Justice sued in July to stop Anthem’s purchase of Cigna, a deal that would have created the largest U.S….
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