CMS hits pause on speeding Medicare payments to docs as COVID-19 funding reaches $175B

Health policy experts and provider groups called the move premature as the financial concerns plaguing doctor's offices and hospitals are unlikely to go away any time soon.

By Rebecca Pifer Parduhn • April 27, 2020

Inpatient COVID-19 cases estimated to cost $14K per patient

Health Affairs researchers also found patients with coronavirus generated costs that dwarfed other infectious diseases, like the flu.

By Hailey Mensik • April 23, 2020

Explore the Trendline➔

Payer/provider relationships

As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.

By Healthcare Dive staff

Medicare still expected to grow to 6% of GDP by 2026, but COVID-19 could speed insolvency

The Medicare Board of Trustees predicts the trust fund that finances Medicare Part A will run out by 2026 — the same estimate as 2018 and 2019's reports due to policy inaction. But the pandemic could worsen the situation.

By Rebecca Pifer Parduhn • April 22, 2020

Oklahoma 1st to seek waiver to block grant Medicaid, despite pandemic

The request, which includes a work requirement and asks beneficiaries to pay premiums for coverage, hinges on Republican Gov. Kevin Stitt's controversial plan for Medicaid expansion.

By Rebecca Pifer Parduhn • April 21, 2020

Obamacare insurers on hook for $2.7B in MLR-based refunds this year, KFF says

The expected owed refunds estimated by the Kaiser Family Foundation come amid a scramble to calculate 2021 rates in the midst of the COVID-19 pandemic and uncertain costs.

By Ron Shinkman • April 20, 2020

Majority of commercial patients may receive surprise bill following ambulance ride

The amount billed to a patient was substantially higher for air ambulance services at a median of nearly $21,700, but ground ambulance rides were more likely to invoke a possible surprise bill, according to a Health Affairs study.

By Shannon Muchmore • April 16, 2020

After largely exiting ACA exchanges, UnitedHealthcare mulls jumping back in

The admission comes as the nation's largest private health insurer said more members are struggling to pay their monthly premiums as workers are laid off or forced to take furloughs in the economic fallout of the novel coronavirus.

By Samantha Liss • April 16, 2020

Could coronavirus derail the decades-long shift to value-based care?

"This is not about managing a population. This is about doing everything you can to keep these people alive," Dean Ungar, vice president of Moody's Investors Service, said.

By Rebecca Pifer Parduhn • April 15, 2020

UnitedHealth marks uptick in members struggling to pay premiums

As employers try to keep their businesses afloat, the payer said it's "deeply committed" to providing premium relief to clients as it benefits from not having to pay for halted elective surgeries, which may outweigh COVID-19 costs.

By Samantha Liss • April 15, 2020

CMS issues guidance to free patients from copays for coronavirus tests

Clinical labs worry Congress hasn't provided funds for the "free testing." But recent legislation gives the labs rates negotiated before the pandemic; or if there wasn't one, allows them to negotiate on price.

By Nick Paul Taylor • April 15, 2020

Molina-NextLevel acquisition falls through

Molina pointed the finger at NextLevel and said the $50 million deal fell through due to the seller's "unwillingness to close pursuant to the terms of the acquisition agreement."

By Samantha Liss • April 14, 2020

Hospital costs to treat uninsured COVID-19 patients could top $40B

The Kaiser Family Foundation analysis is another indication that more funding will be needed to keep the U.S healthcare system running as it faces the unprecedented crisis.

By Shannon Muchmore , Hailey Mensik • April 8, 2020

$30B in CARES funding to be distributed to hospitals this week, Verma says

The money is based on Medicare revenue, not a "first-come, first-serve basis," the CMS administrator said. Hospitals "will get these dollars. Even if it takes a few days, there shouldn't be any panic in the system."

By Rebecca Pifer Parduhn • Updated April 9, 2020

CMS gives 1.66% rate boost to MA, Part D plans for 2021

The pay bump is more than CMS' original proposal of just 0.93%. The agency also went forward with a plan to use more encounter data to calculate risk scores.

By Samantha Liss • April 7, 2020

Utah pauses Medicaid work requirements amid COVID-19

It was the only state running the controversial program that ties Medicaid eligibility to a certain number of work or volunteering hours.

By Rebecca Pifer Parduhn • April 3, 2020

Health jobs plummeted in March despite rising need for healthcare workers

Dentist's offices shed 17,000 jobs, doctor's offices lost 12,000 and other healthcare practitioners lost 7,000 jobs, the Bureau of Labor Statistics reported Friday morning.

By Rebecca Pifer Parduhn • April 3, 2020

How insurers are covering COVID-19

Cigna is extending its out-of-pocket waivers for COVID-19 treatment through the end of October.

By Samantha Liss • Updated July 10, 2020

AHA wants private payers to do more to help hospitals fight COVID-19. Payers say they've done a lot already

"We are working hard to offer billions of dollars of additional resources and enhanced coverage," AHIP SVP of Communications Kristine Grow told Healthcare Dive. "But these resources are not infinite."

By Rebecca Pifer Parduhn • April 2, 2020

Dorm rooms as hospitals, ER telehealth: CMS creates 'unprecedented' flexibility as COVID-19 rages on

Hospital groups on Tuesday applauded the actions from CMS, with the American Hospital Association calling the ability to care for patients outside of hospitals' four walls a "critical lifeline."

By Shannon Muchmore • Updated April 1, 2020

5 FDA approval decisions to watch in the 2nd quarter

The FDA's focus is squarely on responding to COVID-19, yet the agency continues to review new drugs for other diseases. Among them: Roche's SMA therapy risdiplam and Intercept's NASH drug.

By Jacob Bell , Ben Fidler • March 30, 2020

Humana, Cigna join Aetna in waiving COVID-19 treatment charges

CVS Health-owned Aetna first made the policy change Wednesday. Cigna is also deploying staff clinicians to assist its telehealth partner MDLive as more patients turn to virtual visits to avoid coronavirus exposure.

By Shannon Muchmore • March 30, 2020

Trump administration expedites Medicare payments to providers amid coronavirus

CMS advances Medicare payments in emergency situations like natural disasters or to address cash flow issues when there's a disruption in claims submission or processing, based on historical payments to a Medicare provider.

By Rebecca Pifer Parduhn • March 30, 2020

DOJ sues Anthem for millions in overpayments related to MA plan members

The payer said it plans to vigorously defend its practices as the lawsuit alleges it put profits ahead of compliance.

By Samantha Liss • March 27, 2020

'What about us?': Frontline primary care practices fear for survival amid coronavirus

Independent practices have resisted selling to hospitals amid years of provider consolidation, reimbursement cuts and more, leaving them with razor-thin margins. Now, they worry COVID-19 could send them off the financial cliff.

By Rebecca Pifer Parduhn • March 26, 2020

UnitedHealth says self-swabbing study spurred FDA coronavirus policy change

The agency now allows onsite self-collection of samples, after a nearly 500-patient study found self-administered tests about as accurate as those carried out by clinicians.

By Nick Paul Taylor • March 26, 2020