Insurance Reimbursement Articles
Getting paid for drugs demands a robust chain of events linking product procurement, its use within both the clinical framework and payer requirements, and the revenue cycle function of charging, billing and subsequent reimbursement.
Drug reimbursement hinges on a variety of issues. Here are the top five to consider.
Several healthcare associations have identified many challenges of delivering quality healthcare and are working toward implementing solutions.
Even with the coding sets used to reimbursement healthcare expenses, it is sometimes necessary to increase the specificity of the data or to add a contingency of payment by adding modifiers.
The proposed calendar year 2024 Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center (ASC) and Physician Fee Schedule (PFS) payment rule sets are being finalized to begin Jan. 1, 2024.
Healthcare providers across the national have marked well more than a year of consecutive negative margins as they experience the effects of higher expenses.
Financial Challenges remain a consisten t and growing concern for the healthcare industry, so taking actionable steps to produce tangible results can assist the industry in righting itself after uncertain times of financial instability.
The 2022 Inflation Reduction Act significantly changes the U.S. prescription drug pricing regulations, creating a radically different market environment.
A number of payment rule changes and unknown future federal and state regulations loom ahead.
Understanding terms used in rule sets pertaining to payment for inpatients, which go into effect during the fiscal year effective Oct. 1, as well as outpatient and physician fee services, which go into effect during the calendar year effective Jan. 1.
The proposed 2022 outpatient prospective payment system (OPPS)/ambulatory surgery center (ASC) and physician fee schedule (PFS) rule sets impact all pharmacy practices.
In today’s fast-paced healthcare industry, naiveté about payers’ requirements coupled with their supply chain stipulations can lead to reimbursement shock!
