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.
News|Videos|June 19, 2024 (Updated: June 19, 2024)
Congressional perspectives: Evolution of PBMs
Author(s)Richard Payerchin
How pharmacy benefit managers have grown in a bad way.
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Rep. Buddy Carter (R-Georgia), a career pharmacist, discusses his experiences with pharmacy benefit managers, drug discounts that are not helping patients, and vertical integration in health care.
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As physicians, payers and independent reviewers all adopt AI for utilization review and No Surprises Act disputes, audit trails and human oversight will determine which practices come out ahead.
The license fee is the number on the proposal. These 10 costs arrive after the contract is signed, and the biggest never shows up on an invoice.
A new Kodiak report shows prior authorization and medical necessity denials accounted for nearly all of the 25% jump in revenue leakage. Here are four steps practices can take now to fix that.
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?
It's shared savings season and the check has arrived. Now how do physicians divide it up fairly?
Urban Institute analysis finds 26% of insured adults owe medical debt, with hospitals the largest source
Recent CMS rule changes reinforce that operational discipline is increasingly shaping reimbursement
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