HEALTHCARE NEWS

The ACA Premium Subsidies: What’s at Stake in 2025?   As the United States prepares for a potential change in administration in 2025, the future of the Affordable Care Act (ACA) premium subsidies hangs in the balance. Originally expanded during the COVID-19 pandemic under the Am...

The Centers for Medicare & Medicaid Services (CMS) recently released the finalized Calendar Year (CY) 2025 Medicare Physician Fee Schedule (PFS) Rule, which outlines crucial updates and policy shifts for the Quality Payment Program (QPP) beginning with the 2025 performance year. Set to be publis...

Providers are no strangers to the burden of prior authorization, a process requiring physicians to submit detailed paperwork to insurers for approval before administering treatments. Insurers claim this process helps prevent unnecessary medical interventions, saving the healthcare system from wastef...

ICD-10-CM updates don’t often get much fanfare, but this year brings a notable shift for rehab therapists, especially those treating musculoskeletal issues. The longstanding challenges of coding for conditions like lumbar disc degeneration or synovitis—previously hindered by vague, unspe...

While the U.S. has made strides in reducing uninsurance rates, access to quality healthcare remains a complex challenge. We decided to explore the systemic barriers that hinder access to care, the crucial role of research in addressing these issues, and the potential of emerging trends to improve he...

To simplify the healthcare experience and reduce the administrative burden on healthcare providers, UnitedHealthcare is introducing a groundbreaking initiative: the National Gold Card program. Set to officially launch on October 1, 2024, this program represents a major step forward in modernizing th...

Healthcare organizations have increasingly focused on addressing social determinants of health (SDOH) to improve patient outcomes and reduce healthcare costs. SDOH refers to non-medical factors like income, education, environment, employment, and social networks that heavily influence a person’...

On August 16, 2024, Humana Inc. agreed to a $90 million settlement after a whistleblower lawsuit claimed the company overcharged Medicare for prescription drugs. Filed by former Humana actuary Steven Scott, the lawsuit exposed major issues within Medicare Part D and highlighted important takeaways f...

Digital Accessibility Matters The digital age has transformed the way we interact with healthcare. However, for millions of Americans with disabilities, accessing essential health information and services online remains a significant challenge. Recognizing this critical gap, the U.S. Department...

The American healthcare system, once a beacon of innovation, finds itself precariously perched on a financial precipice. Rising costs fueled by advancements in medical technology, an aging population with increasingly complex needs, and stagnant funding from public and private insurers create a suff...

In the fast-paced world of healthcare, Electronic Health Records (EHR) systems have become indispensable. These digital versions of patients' paper charts offer a comprehensive view of patient histories, improving the efficiency and quality of care. However, as the demand for better healthcare servi...

Getting credentialed with insurance companies is an essential step for healthcare providers who wish to accept insurance from patients. This process involves verifying a provider’s qualifications and ensuring they meet the standards set by the insurance company. Here’s a step-by-step gui...

Credentialing processes in healthcare organizations are continually evolving to ensure patient safety and quality care delivery. Here are some updates and best practices:Digital Transformation:  Many healthcare organizations are transitioning from manual, paper-based credentialing processes to ...

 The New York State Public Health Law has been amended to require universal standards for coding of payment for home and community based long term care services claims. Specifically, it requires these codes to be based on universal billing codes approved by the Health Department and be con...

Merit Based Incentive Payment System (MIPS) eligible providers who fail to collect and report a minimum amount of 2017 performance data by March 31, 2018, could face a four percent negative payment adjustment on Medicare reimbursements in 2019 — with increasing penalties in the future.
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