Main Library See More- Visit ACOExhibitHall.com
Billing, antitrust exemption changes upend negotiations between insurers and providers

Billing, antitrust exemption changes upend negotiations between insurers and providers

January 25, 2021Nona TepperNo CommentsModern HealthcareCommercial Payer Contracting

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.

Full Article

: AHA

Related Posts

Most ACOs Worried About Rising Advanced APM Thresholds Next Year

September 22, 2020Garrett Schmitt

Doctors worry CMS proposals will slow the move to value-based pay

July 14, 2018Garrett Schmitt

CMS pushes ACOs to take on risk with overhaul of MSSP: 7 things to know

August 10, 2018Garrett Schmitt

Leave a Comment Cancel reply

Your email address will not be published. Required fields are marked *

Recent Posts

  • RECORDED WEBINAR: Preparing for Risk: Intersection of Compensation Design & Performance Improvement
  • FLASH INTERVIEW — InfoMC, February 2021
  • The digital divide becomes a new social determinant of health
  • Achieving Success in Medicare’s Highest-Risk ACO Program: One ACO’s Story
  • Coordinated payment policies could speed transition to value, experts say
 
Billing, antitrust exemption changes upend negotiations between insurers and providers
  • MENU
    • Main Lobby
    • Vendor Halls
    • Our Team
    • Newsletter
    • Exhibit With Us
    • Testimonials
    • Board Room
    • Live Events
    • Library
    • Contact Us