Payer: Page 142
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Anthem will no longer pay hospitals for outpatient MRIs, CT scans
The payer recently announced it will expand a policy that denies emergency department claims it deems unnecessary.
By Les Masterson • Aug. 28, 2017 -
CMS rejects most payer concerns about greater MA provider network oversight
The agency is demanding more review of Medicare Advantage provider networks to make sure the information is current and accurate.
By Les Masterson • Aug. 28, 2017 -
MemorialCare Health System dropped from Anthem Blue Cross network
This comes amid a number of recent and ongoing payer contract disputes, which are usually resolved soon after patients become affected.
By Les Masterson • Aug. 25, 2017 -
Northwell folds insurance arm CareConnect
The provider cited uncertainty concerning the Affordable Care Act's future and its failure to receive risk corridor payments as reasons behind the decision.
By Jeff Byers • Aug. 24, 2017 -
CareSource will cover final county without an ACA option in 2018
All U.S. counties are now expected to have at least one ACA plan option.
By Les Masterson • Aug. 24, 2017 -
Deep Dive
Clampdown on network directories fueling online solutions
"It’s problematic for both sides,” MGMA’s Robert Tennant says about the effort to keep health plan network directories updated.
By Meg Bryant • Aug. 24, 2017 -
Deep Dive
Hospitals brace for more uncompensated care, lower reimbursements
Talk of major Medicaid cuts and a new way to calculate uncompensated care payments has hospitals worried about the financial downsides.
By Les Masterson • Aug. 23, 2017 -
Small businesses offer competitive health benefits
Employees at small companies take on more of the cost burden than those who work for large companies.
By Shannon Muchmore , Les Masterson • Aug. 23, 2017 -
BlueCross BlueShield of NC dropping grandfathered health plans
The move will affect about 50,000 members, who will be shifted to plans on the state's ACA exchange.
By Les Masterson • Aug. 22, 2017 -
Iowa, Oklahoma seek to create reinsurance programs with ACA waivers
With HHS promoting state innovation, more and more states are asking to waive certain ACA provisions and try their own programs.
By Les Masterson • Aug. 21, 2017 -
UMass Memorial drops out of Medicaid ACO program
The central Massachusetts health system will not be joining 17 other organizations participating in the state's Medicaid overhaul.
By Les Masterson • Aug. 21, 2017 -
Medica to acquire Mayo Clinic's health benefits administration division
The division, which processes and handles benefits administration for self-insured companies, generated about $15 million in revenue last year.
By Meg Bryant • Aug. 18, 2017 -
Oscar posts losses this year, but results better than 2016
The payer has cut back in some areas this year, but expects to expand its footprint in 2018.
By Les Masterson • Aug. 16, 2017 -
CMS proposes to cancel, pare back bundled payment models
A proposed rule would cancel two cardiac programs and reduce mandatory participation for the joint model.
By Shannon Muchmore • Aug. 16, 2017 -
Trump signs bill to fund more private care for veterans
The VA Choice and Quality Employment Act allocates $3.9 billion for the VA, including $2.1 billion for a program that uses government funds to pay for care for veterans living in areas without ready access to VA hospitals and clinics.
By Meg Bryant • Aug. 15, 2017 -
CMS threatens to end NH Medicaid expansion funding
New Hampshire has until the end of fiscal 2018 to change the way the state funds its portion of Medicaid expansion.
By Les Masterson • Aug. 15, 2017 -
Survey: Most Americans not comparing prices for healthcare
Though out-of-pocket healthcare costs have skyrocketed, few Americans are searching for the data on those costs before getting care.
By Les Masterson • Aug. 15, 2017 -
CBO: With no CSRs, premiums increase 20%
A report predicts ending the payments would also mean a $194 billion increase to the federal deficit in the next 10 years, largely because of increased subsidies the higher premiums would require.
By Shannon Muchmore • Aug. 15, 2017 -
Deep Dive
Why ACA market upheaval still looms large despite failure to repeal the law
Whether lawmakers are done with efforts to repeal the ACA or not, some important changes for healthcare could be on the horizon.
By Shannon Muchmore • Aug. 14, 2017 -
Mission Health leaving BCBS of NC network amid contract dispute
The health system said the payer’s proposal, based on quality and health outcomes, would not keep up with rising healthcare costs.
By Les Masterson • Aug. 14, 2017 -
Bundled payment proposals include canceled, scaled-back programs
The proposal reduces the number of mandatory geographic areas for the joint bundled payment program and cancels the cardiac bundled payment program model.
By Shannon Muchmore • Aug. 14, 2017 -
Investors sue Envision Healthcare after surprise billing reports
The investors said company “revenues were likely to be unsustainable” after a New York Times article reported hospitals that hired the company saw more out-of-network emergency room bills and high-paying medical codes.
By Les Masterson • Aug. 13, 2017 -
Study: Hospital costs may be higher for poor Medicare patients
Poorer patients are more likely to be held for observation than admitted to the hospital — setting them up for more out-of-pocket fees.
By Meg Bryant • Aug. 11, 2017 -
Employers focused on care delivery to control healthcare costs
Nearly all large employers plan to offer some telehealth options to their workers.
By Meg Bryant • Aug. 10, 2017 -
Uncertainty influences early premium rate filings for ACA exchange plans
The CMS announced on Thursday it is extending the deadline for insurers to file their rates to Sept. 5. Payers no longer have to decide next week.
By Shannon Muchmore • Aug. 10, 2017
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