Author's posts
CVS Caremark, Walmart reach agreement to continue in-network coverage
CVS Caremark, Walmart disagreed over reimbursement rates in the commercial and managed Medicaid pharmacy network.
CMS considers ending silver-loading in 2020 proposed payment rule
Agency instead offers insurers a reduction in user fees for participating in the Affordable Care Act market.
How providers in South Carolina and Texas are overcoming telehealth obstacles
The two main challenges are proving the value of telehealth and promoting practice change.
Decision support can guide clinicians to prescribe lower cost alternatives
Minor differences in co-payments sometimes mask exponential differences between similar generic formulations.
Patient-directed Utah Health Information Network increases engagement and care management
By empowering patients with a single access point to all their data, the exchange also benefits providers and payers.
ZappRx and Bayer partner to improve access to specialty medications
Providers get a reduced wait time in the prior authorization process, which is usually a manual and paper-based.
CVS Caremark, Walmart clash over reimbursement rates
The retailer is terminating its deal with its PBM, putting commercial and managed Medicaid beneficiaries out-of-network.
Supreme Court hears case over disproportionate share hospital payments
Hundreds of millions of dollars in reimbursement are at stake; $3-4 billion from 2005 to 2013.
Change Healthcare and Health Fidelity partner for greater risk adjustment accuracy
NLP application embedded during coding phase allows for better compliance and more precise reimbursement.
Judge rejects DOJ motion to delay response in CVS/Aetna case due to government shutdown
DOJ also filed a motion to stay the Affordable Care Act appeals case until after funding is restored.
