September 18, 2017 | Julie Miller, Editor in Chief
New Jersey Gov. Chris Christie said that the notorious state of emergency declaration is still in play, but remember that practical developments are on hold until federal officials complete the legwork.
A study of Medicare Part D data from 2016 by the U.S. Department of Health and Human Services Office of Inspector General identifies cases of extreme use of opioids, questionable prescribing and doctor shopping by beneficiaries.
The national conversation about addiction is changing, and as more people seek treatment, managed care organizations will likely give providers a closer look—especially the out-of-network providers that are submitting high-priced claims.
Medicare and Medicaid programs have been rejecting claims for certain diagnoses. It seems the common thread for these rejections is the utilization of certain unspecified diagnoses that are obtained directly out of the DSM-5 purple book.
Federal health leaders say Medicare has already met its goal with 30% of payments now tied to value-based models. Meanwhile, commercial insurers, health systems, employers and organizations have kept a similar pace.