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2 Min Read

Court considers: Can doctors sue insurers for underpaid claims?

In North Jersey Brain and Spine Center v. Aetna, a physician practice that received assignments of benefits from patients with employer-sponsored health plans sued the insurer for denying and underpaying medically necessary surgeries for three different patients.

Judicial Advocacy
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1 Min Read

Avoid 2016 Medicare penalty: Use a registry for quality reporting

Physicians who don’t successfully report for Medicare’s Physician Quality Reporting System (PQRS) this year will face a 2 percent payment penalty in 2016.

Medicare & Medicaid
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3 Min Read

Doctors tell CMS to put the brakes on new medical staff rules

A final rule revising Medicare’s conditions of participation for hospitals could impact physicians’ role in hospital governance and patient care activities. Under the latest final rule, published in May and scheduled to take effect July 11, a multi-hospital health system would be permitted to have a single, integrated medical staff.

Payment & Delivery Models
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2 Min Read

Panel recommends fixes for Medicare ACO exclusivity problems

New recommendations by the Medicare Payment Advisory Commission seek to correct how the Centers for Medicare & Medicaid Services (CMS) attributes patients to physicians so most doctors will be able to participate in more than one accountable care organization if they so choose.

Payment & Delivery Models
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2 Min Read

1 in 3 California hospitalizations stem from diabetes: Study

Patients with diabetes account for one in three hospitalizations in California, according to a new study on diabetes prevalence in the state. The study highlights the impact the disease is having on health care costs.

Chronic Diseases
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2 Min Read

What the future holds for integrated care

Moving health care toward greater integration soon will be crucial for improving costs, quality and access to care, Mayo Clinic Health System CEO Robert Nesse, MD, told physicians earlier this month during the 2014 AMA Annual Meeting.

Payment & Delivery Models
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3 Min Read

How care delivery and payment reform really works

Physician innovators and leaders shared their real-world payment reform experiences during a Monday education session presented by members of the AMA Innovators Committee during the 2014 AMA Annual Meeting.

Payment & Delivery Models
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2 Min Read

Pew got it wrong on advance care planning

There has been a lot of misinformation about advance care planning over the years. The latest in false reporting on this issue is told by Stateline, a news website run by the Pew Charitable Trusts. In an article that appeared this week about possible federal payment policy for advance care planning,

Medicare & Medicaid
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1 Min Read

New care model focuses on patients at risk of hospitalization

A new model of care delivery aimed at improving care for patients most at risk of being hospitalized is being assessed by the Center for Medicare and Medicaid Innovation based on its costs and outcomes. Called the Comprehensive Care Physician model, this care delivery system is intended to give at-risk patients access to a physician who will care for them in both the inpatient and outpatient settings.

Payment & Delivery Models