# Reimbursement Rates * **Definition:** Reimbursement rates refer to the amounts that healthcare providers are paid by insurance companies or government programs for services rendered to patients. These rates can vary based on the type of service, the provider's contract with the payer, and the patient's insurance plan. * **Taxonomy:** Healthcare Topics / Reimbursement Rates ## News * Selected news on the topic of **Reimbursement Rates**, for healthcare technology leaders * 4.1K news items are in the system for this topic * Posts have been filtered for tech and healthcare-related keywords | Date | Title | Source | | --- | --- | --- | | 5/20/2025 | [**Ambulatory Surgical & Emergency Center Services Market 2025: AI, Electrification, and ...**](https://www.linkedin.com/pulse/ambulatory-surgical-emergency-center-fotve/) | [[Linkedin]] | | 5/5/2025 | [**Reimbursement Trends May Reshape Rural Emergency Healthcare Services**](https://www.beckershospitalreview.com/strategy/reimbursement-trends-may-reshape-rural-emergency-healthcare-services/) | [[Beckers Hospital Review]] | | 4/25/2025 | [**Can hospitals 'weather the storms'?**](https://www.beckershospitalreview.com/hospital-management-administration/can-hospitals-weather-the-storms/) | [[Beckers Hospital Review]] | | 4/19/2025 | [**HIMSS Changemaker recommends investing time to mentor - Healthcare Finance News**](https://www.healthcarefinancenews.com/video/changemaker-recommends-investing-time-mentor) | [[Healthcare Finance]] | | 2/24/2025 | [**Rainfall Health Leverages AI to Help Health Systems Achieve Compliance with CMS ...**](https://www.prnewswire.com/news-releases/rainfall-health-leverages-ai-to-help-health-systems-achieve-compliance-with-cms-required-team-model-302383885.html) | [[PR Newswire]] | | 2/5/2025 | [**Wearable Tech Revolutionizes Remote Patient Monitoring - ICT&health International**](https://ictandhealth.com/news/wearable-tech-revolutionizes-remote-patient-monitoring) | [[ICT and Health]] | | 1/30/2025 | [**Sermo Barometer Finds 78f US Physicians Think Health Insurance Companies Have ...**](https://finance.yahoo.com/news/sermo-barometer-finds-78-us-140000719.html) | [[Yahoo Finance]] | | 1/21/2025 | [**Glooko Secures Reimbursement for Remote Monitoring of Gestational Diabetes in France**](https://www.prnewswire.com/news-releases/glooko-secures-reimbursement-for-remote-monitoring-of-gestational-diabetes-in-france-302356198.html) | [[PR Newswire]] | | 1/21/2025 | [**Glooko Secures Reimbursement for Remote Monitoring of Gestational Diabetes in France**](https://www.prnewswire.com/news-releases/glooko-secures-reimbursement-for-remote-monitoring-of-gestational-diabetes-in-france-302356192.html) | [[PR Newswire]] | | 1/13/2025 | [**Embracing Innovation: Home Health Providers Set for a Promising 2025**](https://homehealthcarenews.com/2025/01/embracing-innovation-home-health-providers-set-for-a-promising-2025/) | [[Home Health Care News]] | | 1/3/2025 | [**Q&A: Philips on evolving care models, cybersecurity and digital health's future**](https://www.mobihealthnews.com/news/qa-philips-evolving-care-models-cybersecurity-and-digital-healths-future) | [[MobiHealthNews]] | | 12/31/2024 | [**Funding Challenges for Innovation in MedTech in 2025 - HIT Consultant**](https://hitconsultant.net/2024/12/31/funding-challenges-for-innovation-in-medtech-in-2025/) | [[HIT Consultant]] | | 12/13/2024 | [**Hospitals face 'stable but shaky' 2025: 7 expectations from S&P**](https://www.beckershospitalreview.com/finance/hospitals-face-stable-but-shaky-2025-7-expectations-from-s-p.html) | [[Beckers Hospital Review]] | | 12/13/2024 | [**Kaiser walks back CRNA reimbursement policy**](https://www.beckershospitalreview.com/nursing/crnas-decry-kaiser-reimbursement-policy.html) | [[Beckers Hospital Review]] | | 12/13/2024 | [**Healthcare Revenue Cycle Management (RCM) Market Surges to USD 658.7 ... - PR Newswire**](https://www.prnewswire.com/news-releases/healthcare-revenue-cycle-management-rcm-market-surges-to-usd-658-7-billion-by-2030--propelled-by-24-cagr---verified-market-reports-302331323.html) | [[PR Newswire]] | | 12/12/2024 | [**Growth, integration and affordability: Sutter Health COO looks to 2025**](https://www.beckershospitalreview.com/strategy/growth-integration-and-affordability-sutter-health-coo-looks-to-2025.html) | [[Beckers Hospital Review]] | | 12/9/2024 | [**What's Next for CFOs? Care Access and Clinical Buy-In - HealthLeaders Media**](https://www.healthleadersmedia.com/cfo/what%E2%80%99s-next-cfos-care-access-and-clinical-buy) | [[HealthLeaders Media]] | | 10/18/2024 | [**12 threats stifling ASC success**](https://www.beckersasc.com/leadership/12-threats-stifling-asc-success.html) | [[Beckers ASC Review]] | | 10/17/2024 | [**Healthcare Payer Services Business Research Report 2023-2024 & 2030 - Growth in Telehealth and Virtual Care Services Expands the Scope of Payer Services - ResearchAndMarkets.com**](http://www.businesswire.com/news/home/20241017425707/en/Healthcare-Payer-Services-Business-Research-Report-2023-2024-2030---Growth-in-Telehealth-and-Virtual-Care-Services-Expands-the-Scope-of-Payer-Services---ResearchAndMarkets.com/?feedref=JjAwJuNHiystnCoBq_hl-RLXHJgazfQJNuOVHefdHP-D8R-QU5o2AvY8bhI9uvWSD8DYIYv4TIC1g1u0AKcacnnViVjtb72bOP4-4nHK5ieT3WxPE8m_kWI77F87CseT) | [[Business Wire]] | | 10/17/2024 | [**Healthcare Payer Services Business Research Report 2023-2024 & 2030 - Growth in Telehealth and Virtual Care Services Expands the Scope of Payer Services - ResearchAndMarkets.com**](http://www.businesswire.com/news/home/20241017425707/en/Healthcare-Payer-Services-Business-Research-Report-2023-2024-2030---Growth-in-Telehealth-and-Virtual-Care-Services-Expands-the-Scope-of-Payer-Services---ResearchAndMarkets.com/?feedref=JjAwJuNHiystnCoBq_hl-Q-tiwWZwkcswR1UZtV7eGe24xL9TZOyQUMS3J72mJlQ7fxFuNFTHSunhvli30RlBNXya2izy9YOgHlBiZQk2LOzmn6JePCpHPCiYGaEx4DL1Rq8pNwkf3AarimpDzQGuQ==) | [[Business Wire]] | | 10/16/2024 | [**12 Compelling Sessions to Check Out at HLTH 2024 - MedCity News**](https://medcitynews.com/2024/10/12-compelling-sessions-to-check-out-at-hlth-2024/) | [[MedCity News]] | | 9/12/2024 | [**Financial Viability: Diversifying Revenue and Improving Payer Negotiations**](https://www.beckershospitalreview.com/strategy/financial-viability-diversifying-revenue-and-improving-payer-negotiations.html) | [[Beckers Hospital Review]] | | 8/29/2024 | [**Get used to lower reimbursement rates and learn to adapt: NIC blog**](https://www.mcknights.com/news/get-used-to-lower-reimbursement-rates-and-learn-to-adapt-nic-blog/) | [[McKnights Long Term Care News]] | | 8/14/2024 | [**Digital Therapeutics: The Future of Personalized Medicine - Innovation & Tech Today**](https://innotechtoday.com/digital-therapeutics-the-future-of-personalized-medicine/) | innotechtoday.com | | 7/1/2024 | [**North American Partners in Anesthesia (NAPA): New value-driven MSO/RCM services offer hospitals innovative solutions**](https://www.healthtechmagazines.com/north-american-partners-in-anesthesia-napa-new-value-driven-mso-rcm-services-offer-hospitals-innovative-solutions/) | [[Health Tech Magazines]] | ## Topic Overview (Some LLM-derived content — please confirm with above primary sources) ### Key Players - **Centers for Medicare & Medicaid Services (CMS)**: Responsible for setting reimbursement rates and policies affecting healthcare providers. - **Medicare**: Government health insurance program that has undergone changes affecting reimbursement rates, particularly for biosimilars. - **Heather Cobb**: Administrator at Momentum Specialty Surgery, highlights challenges with low Medicaid reimbursement rates. - **Dr. Eugenio Hernandez**: Chief Medical Officer of Gastro Health, discusses ongoing struggles with reimbursement rates. - **XiFin Pharmacy Solutions**: Provider of tools for pharmacies to monitor reimbursement rates and improve financial decision-making. - **Centers for Medicare and Medicaid Services (CMS)**: The U.S. federal agency that administers the nation's major healthcare programs, including Medicare and Medicaid, influencing reimbursement rates. - **Homecare and Hospice Association of Utah (HHAU)**: Advocates for increased Medicaid reimbursement rates for home and community-based services. - **CommonSpirit**: A health system advocating for fairer reimbursement rates amidst rising operational costs. - **American Medical Association (AMA)**: Advocates for physicians regarding reimbursement rates and the impact of cuts on patient care. - **HealthArc**: A company that integrates remote care management with EHR systems to optimize reimbursements and streamline workflows. - **Walmart**: Retail giant involved in healthcare services, recently closing clinics due to unsustainable reimbursement environments. - **Private Equity Firms**: Investment firms that have significantly influenced healthcare by acquiring physician groups and impacting reimbursement rates. - **Mark Sevco**: COO of Sutter Health, outlines strategies to address financial challenges due to reimbursement compression. - **Advocate Health**: A healthcare system that has achieved significant savings through participation in Medicare programs, emphasizing the importance of value-based care. - **Glooko, Inc.**: A digital health company that provides solutions for diabetes management, recently receiving reimbursement approval for gestational diabetes monitoring. - **Sutter Health**: A health system forming strategic partnerships with Medicare Advantage plans to diversify revenue. - **Sean Gipson**: CEO of Remedy Surgery Center, notes the threat to financial viability of ASCs serving underserved populations. - **Surgical Information Systems (SIS)**: A technology vendor recognized for its role in enhancing revenue cycle management and reimbursement rates for Ambulatory Surgical Centers (ASCs). - **WVU Medicine**: A health system that launched its own health plan to gain control over coverage and improve relationships with payers. - **Hackensack Meridian Health**: Created a joint venture called Braven Health with Horizon Blue Cross Blue Shield to improve care quality metrics. ### Partnerships and Collaborations - **University of Pennsylvania Health System and Independence Blue Cross**: Established a long-term agreement on reimbursement rates effective July 1, 2025. - **Alliance for Connected Care**: Submitted policy requests to CMS to address regulatory challenges and advocate for increased reimbursement rates for remote patient monitoring. - **Interim HealthCare**: Emphasizes the need for partnerships that align with patient care values amidst financial constraints. - **Northwell Health and Nuvance Health**: Merged to enhance healthcare services while addressing reimbursement rates and operational efficiencies. - **HealthArc and athenahealth**: Partnered to enhance clinical documentation automation and patient engagement, optimizing reimbursements. - **WVU Medicine**: Established a payer-provider committee to foster collaboration and address population health challenges. - **COA and Primary Care Providers**: COA emphasizes the need for partnerships with primary care providers to enhance patient outcomes amid changing reimbursement models. - **Payer-Provider Collaborations**: Discussions at the COA Payer Exchange Summit highlighted the importance of collaboration between payers and providers to develop effective value-based care models. - **Braven Health**: A joint venture between Hackensack Meridian Health and Horizon Blue Cross Blue Shield focusing on value-based contracts. - **PsychArmor and CareSource**: Collaborating to enhance training for better support of veterans and military families. - **Ohio State University Wexner Medical Center and Siemens Healthineers**: A 10-year agreement to advance research and improve patient care. - **Walmart and Fabric**: Walmart sold its virtual care subsidiary to enhance virtual care services. - **Advancing Digital Health Coalition**: Formed by merging the American Telemedicine Association's advocacy arm with the Digital Therapeutics Alliance to promote digital health technologies. ### Innovations, Trends, and Initiatives - **Medicaid Reimbursement Reforms**: Proposed solutions to address low reimbursement rates impacting access to care, especially in mental health. - **Rhode Island Medicaid Reimbursement Review**: Governor McKee proposed annual reviews of Medicaid reimbursement rates to better support healthcare providers. - **Biosimilar Reimbursement Provision**: Implemented under the Inflation Reduction Act to improve financial incentives for biosimilar adoption. - **Telehealth and Remote Monitoring**: Increasingly recognized for their value, leading to higher reimbursement rates for home health services. - **Cloud-based Revenue Cycle Management (RCM) platforms**: Increasingly popular for real-time access and efficiency, contributing to improved reimbursement rates. - **Pharmacy Payor Rate Transparency Monitor**: A tool launched by XiFin to provide pharmacies with insights into reimbursement rates, aiding financial decision-making. - **Inflation Reduction Act (IRA)**: The IRA's drug price negotiations are influencing reimbursement rates for oncology providers, prompting advocacy for protective measures. - **Chronic Care Management (CCM) and Remote Physiologic Monitoring (RPM)**: New CMS policies allowing concurrent billing for CCM and RPM, providing financial opportunities for managing chronic conditions. - **Universal Foundation**: CMS proposed framework to streamline quality measurement and reimbursement processes. - **CMS TEAM Model**: A framework mandating improved care coordination and patient-centered treatment plans to enhance reimbursement. - **Value-Based Care Models**: The shift towards value-based care is driving changes in reimbursement strategies, encouraging healthcare organizations to adopt innovative technologies like remote patient monitoring. - **AI-Driven Solutions**: Used by companies like Rainfall Health to enhance patient outcomes and maximize reimbursements. - **Super SNF Model**: A recommended approach for skilled nursing facilities to enhance care delivery and reduce patient transfers. - **AI in Billing**: Over half of healthcare professionals plan to adopt AI-driven billing systems to reduce errors and improve efficiency. - **Digital Therapeutics (DTx)**: Emerging solutions for chronic disease management, with a focus on reimbursement models to enhance adoption. - **Remote Patient Monitoring (RPM)**: Utilizes wearable technology to enhance chronic disease management and improve patient outcomes. - **Digital Health Technologies**: The integration of digital health technologies is being encouraged through government initiatives and reimbursement policies, transforming healthcare delivery. - **Value-Based Care (VBC)**: Healthcare tech CEOs emphasize investing in analytics and IT infrastructure to facilitate the shift to VBC. - **Ontrak Quality**: Utilizes advanced technology and data management to improve quality measures critical for Medicare Advantage and Medicaid programs. ### Challenges and Concerns - **Low Reimbursement Rates**: Ongoing low reimbursement rates from Medicaid and Medicare threaten the financial stability of hospitals and ASCs. - **Declining Reimbursement Rates**: Healthcare providers face financial instability due to reimbursement rates not keeping pace with inflation and rising operational costs. - **Potential Reimbursement Cuts**: Concerns have been raised regarding potential reimbursement cuts for oncology providers as a result of the IRA's drug price negotiations. - **Reimbursement Cuts**: A nearly 3% Medicare payment cut for physicians scheduled for 2025 raises concerns about patient care, especially in rural areas. - **Complexity of Reimbursement Systems**: Healthcare providers face challenges with billing and coding, impacting revenue and operational efficiency. - **Inadequate Reimbursement Rates**: Physicians are compelled to sell practices due to low reimbursement rates, impacting their autonomy and patient care. - **Regulatory Changes**: The need for evolving reimbursement structures to support in-home healthcare and telehealth services. - **Home Health Provider Viability**: Low reimbursement rates from Medicare Advantage plans threaten the financial stability of home health providers. - **Regulatory Uncertainties**: Proposed changes to reimbursement policies create uncertainty for healthcare providers, particularly in rural areas. - **Medicare Advantage Issues**: Providers face challenges with low reimbursement rates and administrative burdens, leading to potential service reductions. - **Strained Relationships with Payers**: Inflation outpacing reimbursement rates has led to severed ties with certain payers and challenges in contract negotiations. - **Operational Costs**: Rising costs for labor and supplies are straining healthcare providers, leading to contract cancellations due to low reimbursement rates. - **Operational Burdens for ASCs**: Ambulatory Surgery Centers (ASCs) are adjusting to declining reimbursement rates and increasing operational burdens due to changing payer policies. - **Prior Authorization Process**: Negatively impacts patient outcomes and physician productivity, complicating the reimbursement landscape. - **Administrative Burdens**: Increased denials and prior authorization requests are causing financial strain on providers, with significant time spent on these tasks. - **Operational Cost Pressures**: Hospitals and ASCs are struggling with rising costs and decreasing reimbursement rates, prompting the need for financial stability strategies. - **Medicaid Cuts**: Proposed cuts to Medicaid raise concerns about the financial viability of ASCs and access to care for vulnerable populations. ## Related Topics [[Reimbursement Policies]]; [[Reimbursement Issues]]; [[Reimbursement Models]]; [[Reimbursement Cuts]]