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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.

CMS proposes 1.7% bump to Medicare payments for dialysis providers

August 5, 2019


CMS last week released a proposed rule that would update Medicare policies and payments for the End-Stage Renal Disease program and aims to promote the adoption of new equipment and supplies among dialysis facilities.

How CMS wants to change Medicare's Physician Fee Schedule in 2020

July 30, 2019


CMS on Monday issued a proposed rule to update the Medicare Physician Fee Schedule and Quality Payment Program for calendar year 2020, which includes proposals intended to reduce physicians' administrative burdens and promote value-based care.

Senate panel approves sweeping bill to lower Rx prices—but changes might be in store

July 26, 2019


The Senate Finance Committee on Thursday voted 19-9 to advance a bipartisan bill aimed at lowering prescription drug costs, but the bill might face opposition in the full Senate unless it undergoes substantial revisions.

Senate will take up 'surprise' billing package after August recess

July 26, 2019


The Senate Health, Education, Labor and Pensions Committee's top Republican and Democratic members on Wednesday said the full Senate would not take up the committee's legislative package to address so-called "surprise" medical bills before Congress' August recess.

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