Tag: cost management

Get Ready: CMS Proposes Numerous Changes to IDR Process

The Federal government recently proposed changes to the NSA IDR process in hopes of holding all involved organizations more accountable and forcing initiating and non-initiating parties to be more diligent in documentation and timely admin fee payments. While the end goal may be to increase speed, efficiency, tracking and transparency, the immediate result is health Get Ready: CMS Proposes Numerous Changes to IDR Process

NSA Minute: Ground Ambulance & Urgent Care Services

NSA currently excludes Urgent Care and Ground Ambulance services despite pressure to do so. However, some states have begun to provide protection. This means self-funded employers must determine which coverage to use. What may seem like the right path may not always make the most economic sense. To ensure the best savings, self-funded plans should NSA Minute: Ground Ambulance & Urgent Care Services

Navigating the No Surprises Act: The State vs. Federal Balance Billing Dilemma

Payers grapple with the complexities of the No Surprises Act (NSA), but self-insured plans face an added challenge in states that allow plans opt-in to state laws instead of the federal law. Selecting between state or federal laws demands careful analysis of factors such as: breadth of protections, data inputs allowed for payment determinations, claims Navigating the No Surprises Act: The State vs. Federal Balance Billing Dilemma

NSA Minute: Separating NSA and Post-Stabilization Codes

As our hearts and prayers go out to Damar Hamlin and his family for a speedy recovery after his on-field medical emergency, we are reminded of the complexities of emergency care, especially if ongoing care is needed. Even after the immediate crisis has passed, post-stabilization care may still be needed. The No Surprises Act has been instrumental NSA Minute: Separating NSA and Post-Stabilization Codes

The Impact of Humira Biosimilars: 5 Factors That Will Reduce Payer Costs

The use of biosimilar products in lieu of originator biologic products has been a hot topic of discussion since the first FDA approval of Zarxio (a biosimilar for Neupogen) in 2015. Since then over 30 new biosimilars have been FDA approved but the biosimilar market hasn’t taken off as expected. The slower than expected uptake The Impact of Humira Biosimilars: 5 Factors That Will Reduce Payer Costs