Payer: Page 144
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ER staffing companies can lead to increased surprise bills
A new National Bureau of Economic Research study found patients who visited in-network hospitals for emergency care received out-of-network physician care 22% of the time.
By Les Masterson • July 24, 2017 -
Parliamentarian review makes passing BCRA even harder
Provisions that cannot be passed through the budget reconciliation process include removing essential health benefits for state Medicaid plans and the defunding of Planned Parenthood.
By Shannon Muchmore • July 24, 2017 -
Centene to open health clinic in Missouri grocery store
The move is part of a broader trend of insurers getting into primary care.
By Meg Bryant • July 21, 2017 -
CMS wants more oversight over Medicare Advantage provider networks
The CMS found in January that 45% of MA provider directories had incorrect information.
By Les Masterson • July 21, 2017 -
CBO: Out-of-pocket health costs would skyrocket under revised BCRA
The newest CBO score doesn't change much of the political discussion currently, but it has some drastic illustrations of how high deductibles and general out-of-pocket spending could get.
By Shannon Muchmore • July 21, 2017 -
Payers see growth opportunities in Medicare Advantage
Humana plans to add 500 employees to handle MA applications during the open enrollment period.
By Les Masterson • July 20, 2017 -
CBO: ACA repeal would cause 32M to lose insurance by 2026
The latest analysis found average premiums in the nongroup market would increase by about 25% next year and nearly double by 2026.
By Shannon Muchmore • July 20, 2017 -
UnitedHealth announces strong Q2 numbers
The company’s Optum business saw its earnings increase 21% in the quarter.
By Les Masterson • July 18, 2017 -
Deep Dive
The BCRA is dead, but don't take your eye off Capitol Hill
The healthcare industry may have dodged a bullet, but this week’s legislative stumbles for the GOP don’t mean healthcare is off the table for Congress. Here's what to watch.
By Shannon Muchmore • July 18, 2017 -
Reducing hospital readmissions not associated with increased risk of death, study finds
The study looks at unintended consequences of CMS’ Hospital Readmissions Reduction Program.
By Meg Bryant • July 18, 2017 -
UPDATE: BCRA, repeal-and-delay plans both dead for now
The GOP won’t easily give up its best chance to repeal the ACA since the law was enacted, but options are dwindling.
By Shannon Muchmore • July 18, 2017 -
Lawmakers prod CMS to collect Meaningful Use overpayments
A recent HHS Inspector General’s investigation found CMS paid more than $700 million to healthcare professionals who did not meet the program's requirements.
By Meg Bryant • July 18, 2017 -
Deep Dive
Despite federal delays, bundled payments will be entrenched in US healthcare
Bundled payment models serve as an entry to value-based care because of the relatively low risk providers take on. While these programs aren't yet proven to be successful, there is enough positive data to support participation.
By Les Masterson • July 17, 2017 -
Kaiser Permanente names 13 to new medical school board
The Kaiser Permanente School of Medicine will admit its first students in 2019.
By Meg Bryant • July 14, 2017 -
American Family Care gets $1B investment in urgent care locations
American Family Care is the largest operator of urgent care centers, and the new deal is expected to add another 300 locations.
By Les Masterson • July 14, 2017 -
Oscar and Humana set sights on small business insurance market
The partnership comes as both companies are looking for new business avenues outside the ACA exchanges, which are struggling with instability amid political uncertainties.
By Meg Bryant • July 13, 2017 -
CMS proposes big 340B drug payment cuts, outpatient rate changes
The agency is also requesting ideas on regulatory and policy changes to advance flexibility, administrative simplification and innovation.
By Jeff Byers , Shannon Muchmore • July 13, 2017 -
Senate Republicans' new draft of healthcare bill makes few changes
The revised draft includes an amendment that would allow insurers to sell plans that do not meet minimum ACA requirements so long as they offer at least one plan that does. The insurance industry has opposed this idea.
By Shannon Muchmore • July 13, 2017 -
Medicare Advantage plans pay physicians about the same as traditional Medicare, study finds
Researchers reviewed 144 million claims for common services from 2007 to 2012.
By Les Masterson • July 12, 2017 -
Anthem Blue Cross expands program that denies claims for unnecessary ED services
The American College of Emergency Physicians and its Missouri chapter said rejecting ED claims is a “clear violation of the national prudent layperson standard.”
By Les Masterson • July 12, 2017 -
ACA is taking a toll on physician-owned hospitals
Physician Hospitals of America says the law stopped the building of 37 hospitals and halted 20 major expansion projects.
By Meg Bryant • July 11, 2017 -
Report: Cutting essential health benefits won't save much money
Republicans on Capitol Hill have raised the idea of cutting EHB requirements as they seek to replace the Affordable Care Act.
By Les Masterson • July 11, 2017 -
Medicaid beneficiaries report high satisfaction, access to care
The survey comes as the program faces a potential restructuring, including massive funding cuts and an end to expansion.
By Shannon Muchmore • July 11, 2017 -
Individual insurance market shows signs of stabilizing, report finds
A new Kaiser Family Foundation report found improved medical loss ratios and payer margins in the first quarter of 2017, but also rising premiums. CMS on Monday announced fewer payers have signed up for ACA exchanges for 2018.
By Les Masterson • July 10, 2017 -
Senate looking at Plan B if BCRA fails
Republican leadership is having a hard time deciding how it should proceed if the votes aren't there to pass their ACA replacement bill, which is increasingly the case.
By Shannon Muchmore • July 10, 2017
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