Day: January 26, 2021

Blog article

Billing, antitrust exemption changes upend negotiations between insurers and providers

A flurry of recent mandates will completely upend the negotiating table between payers and providers, but how the final contracts will change going forward all depend on enforcement.

Although most negotiations between hospital systems and insurers have been finalized for 2021, Rick Kes, a senior analyst at RSM, said recent mandates around surprise billing, price transparency and the antitrust exemption for health insurers will reverberate throughout the healthcare industry for years to come. In late January, CMS also approved a prior-authorization rule that requires payers to build application programming interfaces between their records and providers’, in a move to speed decisions about whether patient procedures are covered. The changes will phase in during 2023 and 2024.

Kes expects the new laws to accelerate hospitals’ move to value-based arrangements with insurers, and drive investment in consumer-centric digital tools that help individuals compare procedure prices between systems.

“The negotiation table has dramatically

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Health News

Air pollution linked to heightened risk of progressive and irreversible sight loss (AMD)

Credit: CC0 Public Domain

Air pollution is linked to a heightened risk of progressive and irreversible sight loss, known as age related macular degeneration, or AMD for short, reveals a large long term study, published online in the British Journal of Ophthalmology.

If these findings are confirmed, they could pave the way for new treatment options, say the researchers.

AMD is the leading cause of irreversible blindness among the over 50s in high-income countries, with the numbers of those affected projected to reach 300 million by 2040.

Known risk factors include older age, smoking, and genetic make-up. But given that ambient is associated with heightened risks of heart and respiratory diseases, the researchers wanted to find out if it might also be associated with a heightened risk of AMD.

They drew on data from 115,954 UK Biobank (UKBB) study participants aged 40-69 with no eye problems at

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