Government: Page 131
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Medicaid FFS biggest factor in billing headaches, report finds
A Health Affairs study found that there are more challenged claims with traditional Medicaid than involving other payers. Also, Medicaid payments take longer to process than others, including Medicare.
By Les Masterson • April 4, 2018 -
Deep Dive
Insurers bracing to hike premiums in 2019 and beyond
Despite worries about the individual market, consumers may not be running for the exits just yet.
By David Lim • April 4, 2018 -
'Nightmare' bacteria found in 221 cases across 27 states
The incidents reported by the CDC were mostly found in hospitals and nursing homes, especially those where patients might be on ventilators for long periods of time.
By Jeff Byers • April 4, 2018 -
Study finds 'pervasive' income disparities in pediatric hospitalizations
The report suggests that hospitals should spend more time on inpatient to outpatient transitions and on population health.
By Meg Bryant • April 3, 2018 -
Payers get better-than-expected Medicare Advantage rate increase
CMS also increased the role encounter data will play in determining risk scores and announced policies to target opioid abuse.
By Les Masterson • April 3, 2018 -
Medicare ACOs missing federal cost-savings predictions, analysis finds
The finding raises questions about the long-term success of the Medicare Shared Savings Program, which has swelled to 561 ACOs from 27 six years ago.
By Meg Bryant • April 2, 2018 -
NQF report finds gaps in post-acute, long-term care measures
The report suggests a need for bidirectional measures that hold both referring providers and nursing homes accountable for care.
By Meg Bryant • April 2, 2018 -
States need more rules to protect individual insurance market
Changes made by the federal government may further destabilize the ACA exchanges, a new Commonwealth Fund report said.
By Les Masterson • April 2, 2018 -
DexCom's glucose monitoring system gets FDA approval
The news opens the door for streamlined review of similar devices.
By Meg Bryant • March 29, 2018 -
Deep Dive
GE, Medtronic among those linking with hospitals for value-based care
Manufacturers are putting their money where their mouth is — tying payment to real outcomes.
By Meg Bryant • March 29, 2018 -
Healthcare M&A leading to higher prices in California
A University of California, Berkeley study said northern California pays much higher healthcare prices than the southern part of the state.
By Les Masterson • March 28, 2018 -
PhRMA goes after drug 'middlemen' in new ad attack
The trade group accused insurers and PBMs of preventing patients from reaching their deductibles by changing how copay coupons are processed.
By Ned Pagliarulo • March 28, 2018 -
Alex Wong via Getty Images
AHA argues HHS religious freedom rule unnecessary
The hospital group is also concerned that the proposed rule may endanger federal reimbursement if OCR takes action against a provider.
By David Lim • March 28, 2018 -
HHS panel recommends testing 2 alternative palliative care payment models
Also, a new Health Affairs article explored the complexity of including hospice care in Medicare Advantage.
By Les Masterson • March 28, 2018 -
Legislation looks to limit length of opioid prescriptions
The American Medical Association has called for more research on the topic and said prescription length depends on situation and type of care.
By Les Masterson • March 27, 2018 -
Plans shirking ACA rules could spur more out-of-network care
Allowing health coverage to be sold across state lines could also limit oversight, a report by state regulators said.
By Les Masterson • March 27, 2018 -
Montgomery County Planning Commission
Aetna to offer point of sale pharmacy rebates to 3M customers
The insurer has opposed the CMS idea to mandate that Part D sponsors pass on a percentage of rebates to customers at the point of sale.
By David Lim • March 27, 2018 -
CMS mum on restricting how payers use subsidies
Insurers that offer ACA plans often use the practice of "silver loading," which involves putting all the losses associated with the end of CSR payments on only silver plans.
By Les Masterson • March 26, 2018 -
Most employers short of tipping point for health coverage
The American Health Policy Institute predicted employers won't be rushing to drop health insurance as a benefit, but some will go that route in the face of unmanageable healthcare costs.
By Les Masterson • March 26, 2018 -
CMS proposes to reduce state Medicaid requirements for monitoring access
The proposed rule is part of the Trump administration's drive to cut administrative red tape.
By Meg Bryant • March 23, 2018 -
Centene fined $100K for not fixing provider network inadequacies
The Washington state insurance commissioner says the payer has not adhered to its compliance plan following a $1.5 million fine last December.
By David Lim • March 23, 2018 -
ACA plan premium changes varied widely
Large premium hikes were connected to marketplace uncertainty, policy changes and payers dropping out of the exchanges, according to the Urban Institute.
By Les Masterson • March 22, 2018 -
Geisinger plans pilot to help patients get to appointments
Geisinger’s program will also provide transportation for non-clinical, but health-related reasons, such as going to counseling, a pharmacy, a grocery store or to a job interview.
By Les Masterson • March 22, 2018 -
White House report targets health insurer profitability
The Council of Economic Advisers report argues many insurance companies' net profit margins have returned to pre-ACA levels on the backs of taxpayers.
By David Lim • March 21, 2018 -
HHS makes case against hospitals' 340B suit in new filing
"Setting aside the final rule for 2018 would direct payments away from these other services while creating administrative havoc in the OPPS system," HHS argued in a court filing this week.
By David Lim • March 21, 2018
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