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In the states: AMA leaves group that opposes 'Medicare for All,' shots fired at an Illinois VA hospital, and more

August 16, 2019


American Health Line rounds up the latest health care news in the states.

An appeals court just reinstated the controversial 2017 DSH payment rule (and it could cost some hospitals millions)

August 16, 2019


A federal appeals court on Tuesday reversed a lower court's ruling and reinstated a 2017 rule that changed how CMS calculates Medicaid disproportionate-share hospital payments to ensure providers are not doubly compensated for care costs covered by third-party insurers.

40% of patients faced 'surprise' out-of-network bills at in-network hospitals

August 14, 2019


The number of U.S. patients who were billed for out-of-network care received at in-network hospitals rose between 2010 and 2016and the costs of those bills increased, as wellaccording to a study published Monday in JAMA Internal Medicine.

Why an iron infusion could cost $412—or $4,316

August 12, 2019


Experts say the common brand-name products used for IV iron infusions in many cases are medically interchangeable—yet providers increasingly are administering the most costly products, leaving patients facing unexpectedly high bills.

Short-term health plans pay out 39% of premiums on care, report finds

August 9, 2019


The top five short-term health plan insurers in 2018 spent only about 39% of premium dollars on medical care, well below the Affordable Care Act's medical loss ratio threshold, according to the National Association of Insurance Commissioners' 2018 Accident and Health Policy Report published last week.

Medicaid DSH payments vary widely by state, GAO finds

August 9, 2019


In four states, Medicaid disproportionate-share hospital payments in 2014 exceeded hospitals' aggregate uncompensated care costs, according to a new Government Accountability Office report—but in 29 states, the payments covered less than half of such costs.

CMS releases national coverage policy for CAR T-cell therapies

August 8, 2019


CMS on Wednesday announced that Medicare will cover FDA-approved CAR T-cell therapies nationwide at health care facilities that meet certain requirements, but the agency did not change Medicare's payment rates for the treatments.

VA inappropriately denied or rejected at least $53M in claims from non-VA hospitals, VA's OIG finds

August 8, 2019


Nearly one-third of claims denied or rejected by Veteran Affairs (VA) claims processors for emergency care at non-VA hospitals were misprocessed during a six-month period in 2017, according to a VA Office of Inspector General report released Tuesday.

What's inside CMS' 2,273-page IPPS final rule?

August 5, 2019


CMS on Friday issued its Inpatient Prospective Payment System final rule for fiscal year 2020, which aims to address payment disparities for rural and urban health facilities and increase add-on payments for emerging technologies and therapies.

CMS finalizes 2020 payment rules for SNFs, hospices, inpatient rehab, psych facilities

August 5, 2019


CMS last week released rules finalizing Medicare payment adjustments for skilled nursing facilities, hospices, and inpatient rehabilitation and psychiatric facilities for fiscal year 2020.

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