Tag Archives: reimbursement

New rule allows Medicare reimbursement to ambulatory surgery centers for knee replacements, stents

Cheryl Clark

About Cheryl Clark

Cheryl Clark (@CherClarHealth) is AHCJ's core topic leader for patient safety, a MedPage Today contributor and inewsource.org investigative journalist. For most of 27 years, she covered medicine and science for the San Diego Union-Tribune. After taking a buyout in 2008, she became senior quality editor for HealthLeaders Media.

Knee replacement surgeries and stenting procedures will now be reimbursed in free-standing ambulatory surgery centers for Medicare fee-for-service beneficiaries as of Jan. 1 under a new rule finalized by the Centers for Medicare & Medicaid Services on Friday.

The controversial policy shift will mean hundreds, if not tens of thousands, of older patients will now have these complex procedures in a facility not attached to a hospital, and will go home the same day. Continue reading

Report: Progress on telehealth adoption by states, but still wide variation

Rebecca Vesely

About Rebecca Vesely

Rebecca Vesely is AHCJ's topic leader on health information technology and a freelance writer. She has written about health, science and medicine for AFP, the Bay Area News Group, Modern Healthcare, Wired, Scientific American online and many other news outlets.

The American Telemedicine Association (ATA), a leading trade group for telehealth providers and advocates, this week released its first report since 2017 that tracks state policies on telehealth.

Telehealth adoption is growing, and more states are embracing policies that improve coverage and reimbursement for telehealth services, according to the report. Lack of reimbursement mechanisms has been one of the biggest barriers to telehealth adoption. Continue reading

Ohio Medicaid program demands new payment strategy after journalists explain how PBMs use ‘spread pricing’

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo: afagen via Flickr

Over the past six months, journalists for the Columbus Dispatch have written more than 40 articles about the murky world of pharmacy benefit managers (PBMs) in Ohio. This week, they wrote one of the most important stories in this ongoing series, “Ohio firing pharmacy middlemen that cost taxpayers millions.”

In this article, they explained that the Ohio Department of Medicaid was changing the way it pays for prescription drugs by, “giving the boot to all pharmacy middlemen” because the Medicaid program wants to shift away from what’s called the “spread pricing” practice. Continue reading

Telehealth gaining wider acceptance but hurdles remain, say #AHCJ17 panelists

Rebecca Vesely

About Rebecca Vesely

Rebecca Vesely is AHCJ's topic leader on health information technology and a freelance writer. She has written about health, science and medicine for AFP, the Bay Area News Group, Modern Healthcare, Wired, Scientific American online and many other news outlets.

Telehealth is a field that is moving towards widespread acceptance, so agreed a panel at Health Journalism 2017 in Orlando.

Many hospitals have some form of telemedicine these days, so covering the topic in a fresh way can be challenging. Continue reading