(Reuters Health)—Many patients who receive assistance from charities set up to defray prescription drugs costs may already have insurance that covers most the cost for their medications, a U.S. study suggests. Researchers examined data on the six largest independent charities offering patient assistance programs through 274 different disease-specific programs. These programs had total revenue ranging…
Drug Makers Met with Trump to Argue against Senate Pricing Bill
(Reuters)—The main pharmaceutical industry lobbying group said on Thursday it and some drugmakers met with President Donald Trump to voice opposition to a bipartisan U.S. Senate bill that aims to lower prescription drug prices. The White House, which has said it backs the legislation, has promised to bring down drug prices for U.S. consumers, an…
White House Scraps Proposal to Lower U.S. Drug Prices
(Reuters)—The Trump administration on Thursday scrapped one of its most ambitious proposals for lowering prescription medicine prices, backing down from a policy that would have required health insurers to pass on billions of dollars in rebates they receive from drugmakers to Medicare patients. The decision represents a new setback to President Donald Trump’s efforts to…
ACR Hill Visits Yield Key Bill Support; Plus Medicare, Biosimilar Wins
Greetings from Washington, D.C., where ACR leaders just held more than 100 meetings on Capitol Hill supporting reforms to step therapy and prior authorization, increased reimbursement for dual-energy X-ray absorptiometry (DXA), solutions to the rheumatology workforce shortage, and rheumatology-specific research at the Pentagon. We’re already hearing great news about our successes: Hours after our visit,…
Medicare Changes Could Have Some Patients Paying More for Drugs
(Reuters Health)—A proposed shift in Medicare coverage for medicines administered by doctors may help reduce total drug spending, but a new study suggests it may also lead to higher out-of-pocket costs for some patients. Right now, drugs given by infusion or injection in outpatient settings are covered by Medicare Part B, which is part of…
Improve Your Claim Submissions Process
Maintaining a health revenue cycle in a medical practice comes with myriad moving parts. Numerous external forces, such as economic conditions, government programs (e.g., the Zone Program Integrity Contractor [ZPIC], the Health Information Technology for Economic Clinical Health [HITECH]) and legislation passed under healthcare reform, mandate healthcare organizations to begin managing internal processes, such as…
Understanding & Preparing for Payer Audits
Audit activity among Medicare and most third-party payers has increased in response to pressure to reduce healthcare costs. The return of billions of dollars to Medicare, Medicaid and third-party programs through these medical audit reviews has also increased. For example, the Government Accountability Office (GAO) 2014 Annual Report estimated that the Centers for Medicare &…
Medicare Participation—Do Physicians Have Options?
Physicians have three contractual options when it comes to the Medicare program: participating, non-participating and opting out. Providers should keep the old saying “look before you leap” at the forefront when considering opting in or out of the Medicare program. Since 2001, physician costs have been on the rise, with only minimal increases in reimbursements,…
U.S. Telehealth Industry Eyes Medicare for Its Next Big Check
(Reuters)—After years of lobbying in Washington, U.S. telehealth providers have the first hints that the dam could break on public funding for an industry they say could save taxpayers billions. Four bills that could be signed into law over the next year carry the solutions to barriers that have prevented the U.S.s’ huge over-65 health…
Medicare Access & CHIP Reauthorization Act Preparation Tips
The ABCs of MACRA The transition year under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is at an end. MACRA repealed the Medicare Sustainable Growth Rate (SGR) methodology for updates to the Physician Fee Schedule (PFS) and replaced it with a value-driven payment system. The new approach to payment is called the…
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