Reimbursement

Excited for the sunset of MIPS? Brace yourself for a replacement, not a repair. Here are four steps to prepare for it.

The proposal from Rep. Frank Pallone Jr. would end independent dispute resolution for care delivered starting in 2028.

Lower pay for telehealth, direct billing for NPs and PAs come up for discussion.

A NAACOS and Innovaccer survey of 116 leaders also found only 21% are tracking which of their patients have enrolled in the new chronic care model.

The CMS-0057 rule regulates health plans. The question that matters is: Which of your payers will be live in your EHR on Jan. 1?

The top news stories in medicine this week.

CMS' proposed cuts to physician fees focus on the operating room. For the primary care physicians managing recovery after surgery, the real gap is much larger.

It's shared savings season and the check has arrived. Now how do physicians divide it up fairly?

A simple break-even calculation turns a reimbursement advantage into staff minutes, showing practices when prior authorization, denials and uncollected patient balances wipe out a better rate.

From AI scribes and coding habits to the claims payers quietly cut, these are the lessons physicians can take from four days of sessions and interviews at the Medical Group Management Association's centennial meeting.

Coding scrutiny, payment gaps and a push for price caps show up across Trilliant Health's annual look at where U.S. health care is headed.

Trilliant Health's annual trends report traces primary care shortages, payment gaps and looming price caps to incentives no single stakeholder has reason to fix.

Medical Economics spoke with MGMA's Madison Hynes about the association's draft bill to ban automatic downcoding, the Patients First Act and AI-run prior authorization in traditional Medicare.

EBRI data show employer plans pay hospital outpatient departments about twice what physician offices receive for the same physician-administered drugs, and the commercial market has barely begun to address the gap.

From a same-day payment cut to AI-run prior authorization in traditional Medicare, MGMA's government affairs team laid out what Washington has in store for physicians next year.

MGMA members described capping Medicare Advantage contracts and favoring commercial patients, while one Texas practice leader reluctantly called Medicare her best payer.

Start with a spreadsheet, add curiosity and communication, and make a real difference to practice income.

Median work RVUs rose no more than 2.8% in any group, while nearly 65% of surveyed organizations plan to add physicians in the coming year.

A primary-care voucher model would pay practices upfront for predictable care and leave insurance to cover catastrophic risk, cutting administrative burden and giving physicians time back with patients.

CMS chief says outcomes-based pay can help patients while finally ending physicians' box-checking frustration.

The top news stories in medicine this week.

Reactions from five leading organizations were among thousands of public comments on the draft document.

Physician groups back ACCESS Model but warn CMS against care fragmentation

Top HHS leaders introduce ACCESS model with discussions of patient health, costs and technology.

The top news stories in medicine this week.