Crush Readmissions & Make Money with Cardiac Rehab
Congestive heart failure is one of the highest-cost diseases driving hospital readmissions and healthcare costs in the U.S. A highly effective treatment for preventing hospital readmissions of heart failure patients is intensive cardiac rehab. The intensive cardiac rehab benefits under Medicare and commercial payers pay physicians and hospitals surprisingly good reimbursement. Congestive heart failure (CHF) […]
Retinopathy of Prematurity: FMV of Pediatric Ophthalmology Services
Premature birth interrupts the normal development of blood vessels in infants’ eyes. If not diagnosed and treated in a timely manner, retinopathy of prematurity (ROP) can result in retinal detachment and blindness. Hospital neonatal intensive care units (NICUs) have a compelling need to contract with pediatric ophthalmologists to provide ROP screening and treatment services. Native […]
Alaska: The Outlier State for Physician Services
Alaska has fewer physician residents-in-training than any other U.S. state except Wyoming. Together with Alaska’s remote location, nine hundred miles from Washington State, these factors create one of the most challenging markets for attracting and retaining physicians. Native Video Player YouTube Player All U.S. hospitals report their numbers of physician residents on their annual Medicare […]
Fair Market Value for Interpretation of Molecular Diagnostic & Genomic Tests
Medical geneticists and molecular pathologists play a major role in the growing fields of genomic testing and molecular diagnostics. Reimbursement for professional interpretation of these tests has fallen through the cracks of a complex system. Native Video Player YouTube Video Player https://youtu.be/xY2ggCJgl9k Medicare reimburses laboratory tests using two different fee schedules. These include the Medicare […]
$17 Billion in Doctor Deals Done By Drug Distributors
$17 Billion in Doctor Deals Done by Drug Distributors Cardinal, McKesson, and Cencora (formerly AmerisourceBergen) have been busy during the past two years. These three drug distributors have spent over $17 billion acquiring large specialty medical groups from private equity sellers. Close review of the target acquisitions reveals a compelling business strategy involving in-office drug […]
Telemedicine Commercial Reimbursement Trends
Telemedicine Commercial Reimbursement Trends The 2025 commercial reimbursement rates for telemedicine are finally here. New commercial reimbursement rates are starting to appear in payor contracts for the 17 new telemedicine codes implemented during 2025. While Medicare still has a statutory requirement to pay telemedicine physician services at in-office rates, commercial insurance carriers are not required […]
Out-of-Network Reimbursement: 3 Things to Know
Out-of-Network Reimbursement: 3 Things to Know Out-of-network reimbursement has completely changed during the past several years. We searched over 40,000 out-of-network payment data files released by major health insurance carriers to identify current trends. #1: Covered OON Services Vary by Plan & Market Health plans have difficulty securing in-network coverage for different types of services […]
2024 Fertility Benefits Commercial Reimbursement
2024 Fertility Benefits Commercial Reimbursement Fertility benefits are no longer just limited to employees of big tech giants like Apple and Meta. A host of major employers now offer their employees tens of thousands of dollars of fertility benefits, including Boston Consulting Group, General Motors, Liberty Mutual, Morgan Stanley, PNC Financial Services Group, and many […]
Commercial Reimbursement for ASCs & Endoscopy Dominated by Chain Operators
Commercial Reimbursement for ASCs & Endoscopy Dominated by Chain Operators Commercial reimbursement rates for over 2,500 surgery centers and endoscopy centers in Cigna’s national Pathwell OAP network validate that national and regional operators negotiate much higher rates than most independent centers. This new data from DataRise™ Commercial Reimbursement Data gives us a rare glimpse into […]
Highest 2024 Hospital Fees Signal New Trend
Highest 2024 Hospital Fees Signal New Trend The most highly reimbursed hospital service during 2024 is the first of a whole new class of treatments. Chimeric Antigen Receptor (“CAR”) T-cell therapy tops the 2024 list, but an even more expensive hospital treatment just hit the market. Native Video Player YouTube Video Player https://youtu.be/itVhSFVm4L0 CAR T-cell […]