Medicare coronavirus vaccine pay rule predicted by month's end, Verma says: HLTH 2020

It's unclear whether CMS has the regulatory power to reimburse for a vaccine if approved by the FDA under an emergency use authorization, as public health officials expect. The rule will likely tackle that.

By Rebecca Pifer Parduhn • Oct. 13, 2020

HHS says hospitals must now report flu data as well as COVID-19 numbers

Facilities will have 14 weeks to comply with the requirement that will inform distribution of treatment and supplies as public health officials worry about a dangerous clash of flu season and the pandemic.

By Hailey Mensik • Oct. 7, 2020

More than 14M may have lost health coverage after historic job losses, study finds

Not all lost jobs result in a loss of coverage, so researchers have been keen to figure out how historic unemployment has ultimately affected insurance status.

By Samantha Liss • Oct. 7, 2020

Citing COVID-19, providers push back on CMS payment rule rate cuts, telehealth rollback in 2021

The AMA and AHA are among those lobbying hard against any payment reduction amid the pandemic. Stakeholders also spoke out against rolling back coverage of audio-only virtual visits and nixing the inpatient-only list.

By Hailey Mensik • Oct. 6, 2020

Medicare advisers toy with MA payment overhaul as major payers expand for 2021

MedPAC commissioners floated a new methodology in the Medicare Advantage program blending local and national spending, but pushback from payers is likely if the change is finalized.

By Rebecca Pifer Parduhn • Oct. 5, 2020

MedPAC commissioners urge condensing, revamping advanced alternative payment models

Many of the models have not produced the results stakeholders and policymakers had hoped for as the group tries to push more providers away from fee-for-service reimbursement.

By Samantha Liss • Oct. 5, 2020

Patients give high marks to telehealth, J.D. Power says

The survey of more than 4,300 people ranked Amwell and Doctor on Demand as well as insurers. Sicker patients were less likely to report a positive experience.

By Ron Shinkman • Oct. 1, 2020

Election 2020: Trump and Biden's starkly diverging views on healthcare

Spoiler: the two nominees diverge on almost everything.

By Rebecca Pifer Parduhn • Oct. 1, 2020

4M added to Medicaid rolls due to coronavirus pandemic

The job market — which many rely on for commercial insurance coverage — is likely to remain strained as long as the U.S. fails to contain the spread of the novel coronavirus. The resulting shift in payer mix is unfavorable for providers.

By Samantha Liss • Oct. 1, 2020

HHS launching effort to better track office-based EHR use

Office-based physicians' responses to surveys tracking health IT utilization have been waning. A new partnership with the American Board of Family Medicine is meant to revitalize data collection to inform future rulemaking.

By Rebecca Pifer Parduhn • Sept. 30, 2020

Anthem to pay almost $40M to settle 2015 cyberattack investigation

The settlement ends a long-standing investigation into the payer following a series of targeted hacks that exposed the health information of almost 79 million people. Anthem continues to deny any wrongdoing.

By Hailey Mensik • Sept. 30, 2020

6.5M Abbott COVID-19 antigen tests to reach states this week

Initial distribution of the rapid point-of-care diagnostics is meant to help reopen economies and schools, President Donald Trump said. It's still far short of the 200 million some experts say are needed each month.

By Greg Slabodkin • Sept. 30, 2020

HHS says nearly $106B in CARES aid has been distributed to providers

Health systems are concerned, however, that new reporting guidelines issued by HHS could stanch the flow of money in the near future.

By Ron Shinkman • Sept. 28, 2020

Trump administration may push back interoperability rules, again: Rucker

HHS is "looking at needed changes" to deadlines for its information blocking rules, ONC head Don Rucker said last week. His comments followed a rule quietly sent to OMB with a title implying extension of certain compliance dates.

By Rebecca Pifer Parduhn • Sept. 28, 2020

Trump health plan called 'pixie dust' on pre-existing conditions, builds on transparency bid

Despite talk by President Donald Trump to preserve pre-existing condition protections, his administration has undermined those protections through litigation and policy decisions.

By Hailey Mensik • Sept. 25, 2020

Experts seek answers on why few Medicaid providers sought COVID-19 relief

Just $2.2 billion of the $15 billion set aside has been paid out as of Sept. 11, a presentation by MACPAC staff found. Commissioners asked if a deadline should be reopened.

By Samantha Liss • Sept. 25, 2020

CMS touts dip in Medicare Advantage premiums for 2021

SVB Leerink analysts point to Centene, Humana and UnitedHealthcare as payers best positioned to pick up more share next year.

By Samantha Liss • Sept. 25, 2020

Biden preferred over Trump on COVID-19, pre-existing conditions, poll finds

Those younger, Black and Hispanic were more likely to list the pandemic as the top concern while older and White voters choose protecting health insurance coverage, The Commonwealth Fund survey found.

By Shannon Muchmore • Sept. 24, 2020

Primary care docs call for federal aid as 1/3 still face significantly low revenue

The new weekly survey from the Larry A. Green Center and Primary Care Collaborative shows a slightly rosier snapshot for primary care providers but suggests trouble ahead amid zero action from Congress and the flu season.

By Rebecca Pifer Parduhn • Sept. 23, 2020

Medicare Advantage should not 'game the system' but prioritize patient care, honest billing

The HHS Office of Inspector General's principal deputy warns, "My office and other government agencies are targeting oversight to make sure plans do not pad risk adjustments with unsupported diagnoses."

By Christi A. Grimm • Sept. 23, 2020

Payers, other stakeholders urge Congress to blunt COVID-19-spurred insurance losses

"The odds are we are on track to having the greatest coverage losses we've ever recorded," Stan Dorn, director of the National Center for Coverage Innovation and senior fellow at Families USA, said during a briefing Tuesday.

By Samantha Liss • Sept. 23, 2020

CMS to expand ambulance prior authorization model nationwide

The model saved Medicare about $650 million in four years without changing care quality or access. However, the timeline for its rollout is still to be determined amid COVID-19 uncertainty.

By Rebecca Pifer Parduhn • Sept. 23, 2020

Georgia practice to pay $1.5M after hacker accessed thousands of patient records

The group calling itself The Dark Overlord used a vendor's credentials and attempted to sell the data, including medical procedures and other personal information, online.

By Shannon Muchmore • Sept. 22, 2020

CMS to push back radiation oncology model after industry blowback

Agency administrator Seema Verma said the upcoming rulemaking will formalize a 6-month delay because "more time is needed to prepare."

By Susan Kelly • Updated Oct. 22, 2020

Hospitals charge privately insured patients 250% more than those on Medicare. The gap is growing.

A RAND study of charge data from more than 3,000 hospitals points the finger at growing provider consolidation as a key culprit, but the AHA slammed the report as "based on a cherry-picked and limited dataset."

By Ron Shinkman • Sept. 18, 2020