The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) is concerned about an emerging pattern among some payors to deny reimbursement of evaluation and management (E/M) codes to physicians who also bill an electrodiagnostic medicine code (e.g., 95886, 95900) on the same day. This practice is not appropriate. There are many patient-physician interactions that clearly requ...

The personalized-medicine concept represents the future of oncology medicine. New genomics technologies will characterize patients biologically in ways that will drive more efficient and effective cancer treatment. Yet the introduction of these technologies is disruptive to current practices in clinical oncology, as well as to current regulatory and reimbursement strategies. The efficient intro...

Increasing accessibility and affordability of healthcare services has been considered as an important policy objective since the beginning of 1980s in Iran. However, current 60- 70% health care out-of-pocket payments create a barrier to an equal access to quality health services, especially in terms of new medicines which affects equity issues and "health" in Iran. Currently, health insurance o...

In 2008, the Association for Molecular Pathology (AMP) Economic Affairs Committee (EAC), under the leadership of the late Dr. Jeffrey Kant, embarked on a project to design new Current Procedural Terminology (CPT) codes for identification and billing of molecular pathology services. At that time, payers were confronted with a dizzying array of highly technical method-based CPT codes that describ...

You are a member of a six-person family medicine practice in a city with a population of one million people in the Midwest. Your practice is very busy, with most commercial patients coming from three major insurance payers in the city. About 60 percent of your practice is commercial and the remainder is largely Medicare. You have very little negotiating leverage with the insurance companies, an...

Despite the importance of patient insurance in the market for prescription pharmaceuticals, little is known about the impact of patient reimbursement on the pricing behavior of pharmaceutical firms. I examine the link between potential patient out-of-pocket expenses and pharmaceutical pricing using a unique policy experiment from Germany. Starting in 1989, a maximum reimbursement for a given me...

Submitted: 16 May 2012; Revised: 8 August 2012; Accepted: 15 August 2012; Published online first: 17 August 2012 Introduction A reference pricing system is a system that establishes a reimbursement level or reference price for a group of interchangeable medicines. If a medicine is priced above the reference price, the patient pays the difference between the price of the medicine and the referen...

BACKGROUND The aim of this study was to review and compare types of reimbursement recommendations for orphan drugs issued by eight European health technology assessment (HTA) agencies and the reimbursement status of these drugs in the corresponding countries. Separate calculations were also performed for three sub-groups: ultra-orphan drugs, oncology orphan drugs and other (non-ultra, non-oncol...