UnitedHealthcare nixes some out-of-network coverage for non-emergencies
Per a policy update that went in to effect July 1, the health insurance giant is not covering non-emergency services that members receive at out-of-network […]
Per a policy update that went in to effect July 1, the health insurance giant is not covering non-emergency services that members receive at out-of-network […]
The government will present its health and care bill to parliament on 6 July setting out major NHS reforms that include scrapping CCGs, formalising the […]
The government will present its health and care bill to parliament on 6 July setting out major NHS reforms that include scrapping CCGs, formalising the […]
The government will present its health and care bill to parliament on 6 July setting out major NHS reforms that include scrapping CCGs, formalising the […]
The Covid-19 pandemic shone a harsh light on how siloed the public health infrastructure is, and the ONC is working along with other government agencies […]
Temporary policy changes during the Covid-19 pandemic let people access substance use treatment over telehealth for the first time. Now, healthcare providers and policymakers are […]
Despite mounting court and legislative scrutiny of pharmacy and prescription benefit manager practices, Amazon has chosen to throw its hat into the discount pharmacy ring. […]
The Supreme Court upheld the Affordable Care Act, dismissing the lawsuit brought by Texas, 17 other states and two individuals on the grounds that they […]
Hospitals and other covered entities are striking a growing number of agreements to use de-identified patient data for research or to develop AI tools. But […]
Given the complex and systemic nature of the country’s crisis, no single solution or course of action can be expected to serve as a panacea. […]
The HHS has extended some of the deadlines for using provider relief funds and reporting on that use. Though the move is mostly positive for […]
The startup will work with the FDA to evaluate the efficacy and safety of current cancer treatments in different groups of cancer patients.
The NHS standard operating procedure (SOP) for primary care will remain in place at least until the government lifts all COVID-19 restrictions, NHS England has […]
Bots may have played a significant role in circulating misinformation during the Covid-19 pandemic, according to a study published in JAMA Internal Medicine. The study […]
UnitedHealthcare is instituting a new policy beginning July 1 that changes how the payer assesses emergency department claims, allowing it to retroactively deny ones it […]
Often overshadowed by its larger, more affluent neighbors to the west, Imperial County had few testing and vaccination resources early on. Now, flush with vaccines, groups […]
To know how Chiquita Brooks-LaSure will lead the Centers for Medicare and Medicaid Services, we sat down with Matthew Hittle, a former senior adviser to […]
The lawsuit alleges that the policy is akin to forcing employees to participate in a medical experiment as none of the vaccines available have received […]
As the nation continues to reckon with disparities in health, we have a real opportunity to remove barriers to proper kidney care.
An action plan shared by the FDA earlier this year showed how the regulator is thinking about future regulations for AI and machine learning in […]
While physicians face incredible pressures to consolidate or receive investment to survive, there are ethical, legal and practical considerations doctors must seriously consider before deciding […]
Can an industry coalition help craft policy to support the use of Real-World Evidence? Five prominent real-world data and analytics companies are betting on it, […]
A petition demanding the resignation of NHS England’s primary care medical director over calls for GP practices to offer all patients face-to-face appointments has been […]
BMA GP leaders have delivered a damning vote of no confidence in NHS England amid widespread anger over a letter ordering practices to offer all […]
Having access to affirming spaces and living with people who respected their pronouns made a big difference in LGBTQ kids’ mental health, according to a […]
What You Should Know: – Zing Health Enterprises, a physician-founded and led provider of Medicare Advantage health plans, has signed definitive documents to acquire Harrisburg, […]
Covid has pushed state health agencies to use Medicaid in ways that would never have been imagined before. With one in five Americans saying they […]
Two healthcare conferences with in-person events slated for later this year will require people to be vaccinated. HIMSS’ annual conference, which will be held in […]
NHS England’s medical director of primary care is facing calls to resign in the wake of a widely-condemned letter ordering practices to offer all patients […]
America’s abysmal record on maternal care outcomes and equity has spurred the rise of startups as well as innovative strategies from providers and payers, each […]
Use of mental health and substance use services fell by double digits last year for adults and children covered by Medicaid and CHIP, according to […]
The hospitals are pushing HHS to recognize patients eligible for Medicaid under the ACA as “low-income” when calculating Medicare disproportionate share hospital payments in states […]
Uninsured Older Americans Have Worse Cancer Outcomes than Medicare Beneficiaries Study shows a dose-response effect on survival that varies by the robustness of insurance coverage. […]
Ellume, a startup that won a $232 million contract to manufacture more of its over-the-counter Covid-19 tests in the U.S., has started building a manufacturing […]
Let’s be careful and deliberate about what we decide to do with vaccine passports. Considerable consequences to individual freedoms – as well as both societal […]
Eleven provider organizations sent a letter to HHS urging them to reconsider the new rules around quality measurement and reporting for ACOs. One of the […]
CMS has adopted several new rules that will change how the Affordable Care Act exchanges operate next year. These include rules that will lower out-of-pocket […]
As demand for behavioral health services increased during the pandemic, many organizations providing these services cancelled or rescheduled appointments, or laid off staff, according to […]
Executives at large companies feel that the cost of providing employee health benefits will become unsustainable within the next decade, a new survey shows. They […]
Patients are not the only ones who will benefit from the price transparency rule — providers and payers can also gain competitive advantages as a […]
CMS has released its proposed inpatient payment rule for fiscal year 2022, which includes a payment bump that could increase reimbursement for hospitals by $2.5 […]
The government’s proposed changes to HIPAA aim to provide guardrails against data breaches and misuse, but some of the modifications may not work as intended. […]
After the Federal Communications Commission awarded $200 million to help healthcare providers purchase telehealth equipment, more than half of the awards went to equipment for […]
Unless the Supreme Court strikes down the ACA, it will remain in place for the foreseeable future and will see expansion.
In the final days of the Trump Administration, the Department of Health and Human Services sought to deregulate 83 different types of medical devices, citing […]
After the Food and Drug Administration authorized a swathe of over-the-counter tests for Covid-19, pharmacies are preparing to stock their shelves. But at $20 to […]
Trey Keller, VP of Product Management at Edifecs Aaron Fulner, Sr. Director at Edifecs With a new administration looking to reshape healthcare policy and additional […]
A Surgical Emergency Exposes the Crisis of the Young and Uninsured When a patient looked anxious before emergency surgery, it turned out he was worried […]
President Joe Biden has submitted his discretionary budget for 2022 to Congress. Among its healthcare provisions are funding requests for the CDC, mental health and […]
In a review of 130 FDA-cleared AI tools, researchers found that the vast majority of them relied on retrospective studies. Most of the developers also […]
No matter if Democrats or Republicans are running the show in Washington, here are three solid bets for pharma companies to plan for in the […]
Historically, providers had to meet certain criteria and address three key areas in the patient’s progress notes: patient history, physical exam and medical decision making. […]
Nonprofit hospitals get substantial tax subsidies with the expectation that they will provide higher levels of charity care to needy patients. But these hospitals spend […]
Nadine Peters, chief legal officer of Cota Healthcare, shares her journey to leadership in health data privacy law and policy recommendations for the Biden Administration […]
Only with proper coverage and access to the modern technologies that made their mark during Covid-19 can we truly democratize healthcare and make the promise […]
The family of Dr. Lorna Breen, an emergency physician working on the front lines of the pandemic who died of suicide, is working with Congress […]
People Should Prove They’ve Earned the Right to Have a Gun A consistent feature of many mass murders in the US is easy access to […]
California Attorney General Xavier Becerra may have won a narrow confirmation to be the Department of Health and Human Services Secretary, but if his past […]
Researchers are investigating whether a built-in race adjustment in spirometers could further exacerbate health disparities caused by the pandemic. The medical device is commonly used […]
Areas that have been hit hardest by the Covid-19 pandemic are falling short when it comes to vaccine access. Community leaders are pushing to bring […]
The federal price transparency rule for hospitals went into effect Jan. 1, but a new analysis shows that a majority of providers studied were “unambiguously […]
President Joe Biden recently signed the $1.9 trillion Covid-19 relief package into law. The American Rescue Plan Act includes several provisions to boost coverage under […]
Addressing Vaccine Hesitancy in Communities of Color [OpEd] The numbers are sobering: In just over a year since the coronavirus first appeared in the United […]
Addressing Vaccine Hesitancy in Communities of Color [OpEd] Vaccine hesitancy is common in communities of color based, in part, on historical harms inflicted by health […]
While telehealth use soared last year, the biggest increases were among adults living in metropolitan areas with low poverty levels, according to research published in […]
In an address on Thursday, President Joe Biden directed states to make all adults eligible for the Covid-19 vaccine no later than May 1. To […]
Did Medieval Medicine Pave the Way for Value-Based Payment A new book about Medieval Medicine reveals that many factors that influenced medicine then are the […]
Several California counties and Washington state dropped One Medical as a partner in distributing vaccines after reports that it let people who weren’t eligible for […]
A new CMS rule would require insurers to cover Covid-19 tests, even for asymptomatic patients. It builds on previous legislation requiring payers to cover the […]
Why Infertility Treatments Should Be Covered by Insurance Although it’s improving, most insurance coverage for infertility treatment doesn’t match that provided for other conditions. Here’s […]
President Joe Biden’s pick for CMS administrator, Chiquita Brooks-LaSure, is slated to become the first Black woman to hold the post. Her policy priorities will […]
In an alert on Friday, the Food and Drug Administration warmed that pulse oximeters might be inaccurate in some circumstances. The agency listed skin color […]
Hospital counsel, state advisors, congregate care advocates and university leaders believe that public health ethics must drive the next steps in vaccine distribution and not […]
At a Health Datapalooza session, former HHS head Kathleen Sebelius looked back on lessons learned in 2009 when the Affordable Care Act was moving through […]
The Biden administration should recognize that including high quality, patient-centered comprehensive medication management (CMM) services as the national standard of care will improve patient outcomes, […]
Several states passed recent laws that would require commercial insurance plans to cover more telehealth services on a permanent basis. More states now require health […]
Two UnitedHealthcare policies have raised several concerns among providers, including that they may display anti-competitive behavior and could block patient access to certain healthcare services. […]
Walgreens, CVS, Walmart and dozens of other pharmacies will start administering a limited number of vaccines as part of the Federal Retail Pharmacy Program. It […]
Ellume, whose at-home Covid-19 test was cleared by the FDA in December, got a $232 million contract from the Department of Health and Human Services […]
As states begin to roll out vaccines to the broader public, Google will make it easier for people to find out when they are eligible […]
Dr. Fauci stressed that whether humanity can root out the novel coronavirus depends on whether a robust global vaccine campaign can be launched such that […]
Amazon, Walmart, Starbucks and other retailers are offering to play a bigger role in helping distribute Covid-19 vaccines. In most states, essential workers are still […]
In an interview with MedCity News, Amwell CEO Dr. Roy Schoenberg shared how attitudes around telehealth have changed and what he’s watching for in future policy.
The agency published its first action plan last week for how it plans to regulate machine learning-based software as a medical device. To start, the […]
The Medicare Coverage Gap: What Will the Donut Hole Look Like in 2021? The Medicare coverage gap is present in most Medicare plans,but it’s been […]
While the ultimate litigation effects of the COVID-19 pandemic remain to be seen, the current high-profile healthcare claims are as varied as product liability and […]
The scientific adviser who guided U.S. efforts to speed up development of vaccines for Covid-19 is resigning at the behest of the incoming Biden administration.
Flo, a popular period-tracking app, reached a settlement with the FTC over allegations that it misled users about how their health information would be shared. […]
Despite concerns over broadband access and reimbursement, telehealth still brings many opportunities to care for patients covered by Medicare and Medicaid, panelists said at CES.
The CEOs of Pfizer, Moderna, McKesson and CVS Health explained that the distribution effort has gone well but the administration of the vaccine has now […]
AI tools increasingly occupy a regulatory gray area in healthcare. For clinicians to assess whether they are trustworthy, they need transparency on how they work, […]
In a wide-ranging discussion at J.P. Morgan’s Annual Healthcare Conference, former CMS Administrator Andy Slavitt talked about the future of the ACA, telehealth and Medicare […]
In an unusual move, the Food and Drug Administration issued an alert about false negatives in startup Curative’s Covid-19 test. The test was being used […]
A group of hospitals have sued HHS Secretary Alex Azar, arguing he should reverse a policy that prevents hospitals from getting reimbursed for Medicare-related bad […]
A new variant of SARS-Cov-2 thought to be more transmissible was discovered in Colorado’s eastern plains and San Diego, California. At the same time, federal […]
A new variant of SARS-Cov-2 thought to be more transmissible was discovered in Colorado’s eastern plains and San Diego, California. At the same time, federal […]
What You Should Know: – Regence and MultiCare ink first-in-the-nation value-based care partnership to deliver improved health outcomes at lower costs. Health insurance provider Regence […]
Dentists: An Untapped Resource for Equitable COVID-19 Vaccine Distribution Why dentists should be an integral part of the COVID-19 vaccine distribution & administration: broad reach, […]
What Will Healthcare Look Like in a Post-COVID-19 World? (Part 1) Notes from HLTH VRTL 2020: The future of healthcare post-COVID and anticipated impacts of […]
Hurdle Health, a mental health startup that trains culturally competent therapists, has seen continued growth over the last year. Its founder and others are working […]
The company’s vaccine is the second approved for emergency use by the FDA. It is expected to pose fewer logistical challenges than the first, which […]
What lessons can future Covid vaccine candidates take from the FDA’s response to Pfizer and Moderna’s study data?
The HHS has proposed changes to the HIPAA Privacy Rule — the biggest in seven years, a healthcare lawyer said. But while the changes aim […]
The vaccine was developed in record time, a big scientific accomplishment, even though the agency’s move follows an unusual level of pressure from President Trump’s […]
The nonbinding recommendation is a final hurdle before an official emergency use authorization for the vaccine, which could be the first shot approved for use […]
A fiercely liberal state senator from Los Angeles and a moderate Assembly member from the Central Valley are joining forces to pressure Newsom to make […]
President-elect Joe Biden named Xavier Becerra, the current California attorney general, as his nominee for HHS secretary. A 12-term congressman and vocal supporter of the […]
The final physician payment rule for next year includes changes to the list of telehealth services covered by Medicare and updated payment policies for remote […]
In the Face of a Medicaid Tsunami, Telehealth is More Important Than Ever Telehealth utilization under Medicaid surged during the pandemic providing needed services to […]
Rosemarie Day has been a long time health care consultant and operator, most prominently as the COO of the Massachusetts Health Connector–the first real state […]
Recent efforts to improve transparency haven’t made much of a difference, one author noted. But earlier reforms made a dent the “most egregious” practices.
A health journalist, a physician and a former foreign correspondent sits down with Dr. Anthony Fauci for a lengthy Q&A about safety during Covid times.
The states are trying to prove they were harmed by the 2010 health law — and thus have “legal standing” to challenge its constitutionality.
What You Should Know: – White house coronavirus task force doubles down on rapid testing strategy to fight the coronavirus as some states say they […]
Now with a 6-3 conservative majority, the nation’s highest court still seems reticent to throw out the Affordable Care Act altogether. If the law stays […]
The news sent the stock market soaring as it represents a key milestone in developing and distributing a vaccine for the virus. Still public confidence […]
Physician Compensation 2020: How Much Money Do U.S. Doctors Make Per Year? Doximity’s Physician Compensation report revealed that income growth slowed and the gender wage […]
Conservative vs. Liberal Views of Social Change: Who’s Right? Can conservative vs. liberal views be married in order to come up with social policies that […]
States are trying to strengthen their hand over drug prices in light of stalled federal efforts and their own budget crunches. The wildcard is whether […]
The final rule requires insurers to disclose information on prices for healthcare services and cost-sharing with patients. The government says it will help lower prices, […]
Scrutiny of drug prices will continue whether Trump or Biden wins. But pharma can take steps to address critics and cut costs before they reach […]
Expanding Medicaid and then adjusting Medicare coverage based on financial and income status would be one way to improve healthcare policy and make sure that […]
What You Should Know: – Intermountain Healthcare and Sanford Health sign a letter of intent to merge that will created a combined health system employing […]
Vanessa Kuhn, Director of Health Policy, PatientPing The Centers for Medicare and Medicaid Innovation (CMMI) created the Direct Contracting Model to expand opportunities for more […]
After Nebraskans cast their vote for Medicaid expansion in 2018, the state is finally expanding coverage to more residents. As part of the state’s rollout, […]
Starting in January, Medicare will pay $75 for tests that take longer than two days, and will only pay $100 per test to laboratories that […]
With a new nominee as the Supreme Court prepares to hear a case that could determine the future of the Affordable Care Act, the health […]
HLTH aimed to reflect on the success of the decade-old Center for Medicare and Medicaid Innovation (CMMI) by a panel discussion with its directors. Except […]
San Diego-based diagnostics startup Cue Health won a $481 million from the Department of Health and Human Services and the Department of Defense to produce […]
Medicare doesn’t currently cover drugs approved under emergency use designations. But CMS Administrator Seema Verma said the agency was coming up with a plan to […]
Fake Health News: How to Recognize It So You Can Stay Safe Fake health news stories are flooding the internet. Here’s how you can determine […]
Resources to Help You Get Out (and Protect) the Vote The election is just weeks away, and we’re grateful to Dr. Pat Salber for giving […]
What You Should Know: – Humana Inc. and Fresenius Medical Care North America (FMCNA) today announced an agreement to broaden their collaboration toward improving the […]
The guidance calls for a median two months’ worth of follow-up safety data from well-designed Phase III studies as a precondition for a vaccine receiving […]
What You Should Know: – Walmart announced it will begin selling Medicare insurance plans during this year’s annual enrollment period, Oct. 15 through Dec. 7. […]
HHS will renew its contract with TeleTracking Technologies for another $10.2 million. Earlier this year, HHS controversially shifted Covid-19 data collection to the company from […]
While the White House and doctors at Walter Reed have sought to reassure the public that Trump’s condition is improving, he has received numerous drugs […]
The company said it was meeting real-time supply demands for Veklury (remdesivir) in the U.S. and anticipated meeting global demands for the drug worldwide. AmerisourceBergen […]
In the latest video installment from INVEST Digital Health, venture capitalist Michael Yang, Managing Partner, OMERS Ventures, and healthcare entrepreneur Shawn Wagoner, Chief Revenue Officer, […]
What You Should Know: – Molina Healthcare acquires New York-based Medicaid managed care organization Affinity Health Plan for $330M in cash serving members in New […]
Reuters reported Wednesday that U.S. regulators would look at data from previous clinical trials that came from the same scientists who created the vaccine, AZD1222, […]
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The Office of the National Coordinator for Health Information Technology will update data measuring physician use of health IT systems, as well as physician burden […]
A review published in JAMA found that bills introduced into the House and Senate don’t go nearly as far as existing drug pricing regulations other […]
The FDA commissioner took to Twitter Monday night to defend his performance at the agency, which came under sharp criticism amid accusations that the authorization […]
The biotech company reached a deal with the European Commission to supply an initial 80 million doses, while European Union member states will have the […]
While the emergency use authorization granted Sunday was not seen as scientifically unwarranted, it drew concerns from some experts that it could hinder enrollment in […]
Over the weekend, Trump called the agency, without evidence, part of a “deep state” that was slow-walking vaccines and drugs for Covid-19. The next day, […]
In a survey of 730 parents, 31% of them plan to keep their child home if schools open for in-person instruction, according to a survey […]
Managing Cultures During Physician Practice Merger Culture is the most common reason why practice mergers fail. However, there are steps you can take to end up […]
The New York Times reported that the FDA was prepared to issue an emergency use authorization for the treatment last week, but NIH Director Francis […]
Some healthcare startups that offer at-home prescription deliveries and test kits have experienced delays with the USPS. They shared how they’re navigating the changes.
A U.S. district judge blocked a rule by the Department of Health and Human Services that would end anti-discrimination provisions protecting transgender patients. In his […]
The Centers for Medicare and Medicaid Services issued fines to more than 3,400 nursing homes either for infection control noncompliance or for failing to report […]
Earlier this month, Ohio Gov. Mike DeWine received a false-positive result from a rapid antigen test for Covid-19, raising concerns about the tests’ accuracy. The […]
HHS’ Office of the National Coordinator will allocate $2.5 million in CARES Act funding to health information exchanges to support public health uses of information […]
The agreement, which includes 100 million doses of mRNA-1273 and an option to acquire 400 million more, brings the total amount of money the biotech […]
Russian President Vladimir Putin said a vaccine developed at a Moscow research institute that appears to still be in Phase I development among fewer than […]
In this episode of MedCity Pivot podcast, we discuss Zeke Emanuel’s book where he asks the question – which country has the best healthcare in […]
Health information exchanges know about the hard work of building trust by delivering value in healthcare. They have been in these trenches. They need a […]
Under the agreement with BARDA and the Department of Defense, the drugmaker would supply 100 million doses of its vaccine, for which it published preclinical […]
Several federal agencies, including the Centers for Medicare and Medicaid Services, have indicated their interest in expanding telehealth coverage after the federal emergency period ends. […]
The executive order would call on the Department of Health and Human Services to develop a new pilot payment model for rural hospitals, and would […]
Three of the companies making drugs used in the Phase II I-SPY COVID-19 study – Amgen, AbbVie and Takeda – announced the patient enrollments Monday. […]
Financial terms of the deal were not disclosed, but it follows a $1.95 billion contract between the two companies and the U.S. government. Assuming clinical […]
The companies will provide 100 million doses of their jointly developed vaccine. But with a Phase I/II study planned in September, it is behind in […]
The company had received $483 million from BARDA in April to fund the development of the vaccine, mRNA-1273, through Phase III, but that amount was […]
Google has reportedly pledged not to use Fitbit’s user data for its advertising business. With the deadline quickly approaching, is it enough that European regulators […]
Does the US Have a Physician Shortage or a Physician Training Shortage? The number of medical school graduates greatly exceeds the number of 1st-year residency […]
Several states have enacted changes to make it easier for patients to access mental health services via telehealth during the pandemic. Here’s a summary of […]
New Long-Term Care Benefits Added to Medicare Advantage Plans Medicare’s coverage of long-term care is limited, but new benefits added to some Medicare Advantage plans […]
Amid fears of a premature emergency use authorization for a Covid-19 vaccine granted for political reasons, the guidance that the FDA released at the beginning […]
A bill introduced to the U.S. House of Representatives on Thursday would permanently lift site restrictions for Medicare patients to access telehealth. During the pandemic, […]
A joint report by cybersecurity agencies in the U.K. and Canada, endorsed by their U.S. counterparts, states that the hacker group Cozy Bear had been […]
Researchers at the Urban Institute found that up to 10 million people could lose their job-based insurance due to Covid-19 by the end of the […]
The FDA’s Oncologic Drugs Advisory Committee will convene Tuesday to discuss the drug, belantamab mafodotin. Despite the drug’s first-in-class potential, the briefing document for the […]
Why Medical Translation and Medical Interpretation Services are Key in Quality Healthcare All industries need translators and interpreters who are trained in different languages. Although […]
The NIAID create the Covid-19 Prevention Trials Network by combining four existing ones, primarily focused on HIV and AIDS, which will continue that work in […]
A proposed rule by the Centers for Medicare and Medicaid Services would expand payments for new dialysis machines when used at-home.
The contract covers manufacture and supply of the two-antibody drug cocktail REGN-COV2. The company had announced Monday that it entered the drug into three late-stage […]
Reflections on Death with Dignity Facing a painful death from incurable cancer, Brittany Maynard had to move to Oregon so she could control her destiny […]
Can You Believe in Science and Still Vote for Trump? Most people understand the primacy of scientific facts in ordering our personal and public life, […]
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