Payer: Page 146
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Providers waiting for guidance on new Medicare ID cards
Cards with new ID numbers called Medicare Beneficiary Identifiers will be issued in April 2018, and no cards with old numbers will be accepted as of 2020.
By Meg Bryant • June 23, 2017 -
Deep Dive
5 highlights from the Senate's ACA replacement bill
The 142-page bill has many of the same provisions as the House version passed last month, but it comes with some key differences as well.
By Shannon Muchmore • June 23, 2017 -
Cigna eyeing M&A activity, Medicare Advantage growth
The CMS recently lifted Cigna’s 17-month suspension on selling MA plans.
By Les Masterson • June 22, 2017 -
UPDATE: Senate version of AHCA cuts Medicaid differently
AHA President Rick Pollack said of the bill, "Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance."
By Shannon Muchmore • June 22, 2017 -
Anthem pulls back on ACA exchanges while Oscar expands footprint
Many payers said they remain committed to the ACA exchanges. They could still change their minds before 2018, though, as Wednesday's deadline was not the final one.
By Les Masterson • June 22, 2017 -
Qliance's demise brings questions about direct primary care model
At its peak, Qliance served 35,000 patients at clinics in the Seattle area, but that number dropped to 13,000 earlier this year.
By Les Masterson • June 21, 2017 -
Study shows patients aren't protected from surprise bills
Only six states provide a “comprehensive approach to protect consumers," but even those laws have loopholes.
By Les Masterson • June 21, 2017 -
On exchange deadline day, states are hoping for commitments
A new report from Avalere found that residents in more than 40% of counties may have only one payer option in their 2018 ACA exchange market.
By Les Masterson • June 21, 2017 -
CMS proposal exempts another 134K from MACRA
The agency is continuing to give small and rural providers a reprieve. In May, more than 800,000 clinicians were informed they will not be evaluated under the MIPS program.
By Jeff Byers • June 20, 2017 -
Deep Dive
Alzheimer's patients need special care, but providers aren't ready to give it
One in 10 Americans 65 and older has Alzheimer’s disease, which is expected to cost nearly $260 billion this year.
By Les Masterson • June 20, 2017 -
UnitedHealth, Aledade partner on Medicare Advantage accountable care program
More than 15,000 of UnitedHealth’s MA members are eligible for the Arkansas-based program.
By Les Masterson • June 19, 2017 -
ER visits up, uninsured visits down in Medicaid expansion states
The study’s lead author said the impact of Medicaid expansion varied greatly depending on the state.
By Les Masterson • June 19, 2017 -
MedPAC suggests MIPS overhaul, more site-neutral payments
The committee's June report calls for faster changes to the post-acute care settings prospective payment system, but the AHA doesn't support such a change.
By Shannon Muchmore • June 19, 2017 -
Evergreen Health to go for-profit in Maryland insurance market
Allowing Evergreen, originally a nonprofit insurer, to compete in Maryland’s individual health plan market serves the public interest, Insurance Commissioner Al Redmer said.
By Meg Bryant • June 16, 2017 -
Oscar, Cleveland Clinic team up to offer health plans in Ohio
The payer has also signed on to offer plans for small business employers on the HealthPass New York exchange.
By Meg Bryant • June 16, 2017 -
Cigna can sell Medicare Advantage plans again
Some believe the news could be the harbinger for a potential Cigna-Humana merger.
By Jeff Byers • June 16, 2017 -
House sets expectations for VA-Cerner contract
The new Military Construction and Veterans Affairs Appropriations bill includes $65 million for EHR modernization.
By Meg Bryant • June 14, 2017 -
Oscar unveils clinical dashboard to enhance patient profiles
The dashboard can merge with hospitals and telehealth sessions to provide doctors with discharge summaries and consultation notes.
By Meg Bryant • June 14, 2017 -
Sutter Health, Aetna to launch jointly-owned health plan
The joint venture aims to improve engagement "through combined data analytics that identify at-risk patients sooner and provides them with earlier access to care."
By Ana Mulero • June 14, 2017 -
CMS actuary paints rosier picture of AHCA outcome than CBO
The report points to a few potential detriments from a key theme in the AHCA of turning more regulation to the states, including a “possibly failing individual market” and premiums that “would become unaffordable.”
By Shannon Muchmore • June 14, 2017 -
Alex Wong via Getty Images
Deep DiveWhy HHS' sparse, controversial payroll worries the healthcare industry
The slow trickle of staffing up at HHS is putting providers on hold, while the hires that have been announced are causing concern in the industry.
By Shannon Muchmore • June 14, 2017 -
OIG: Medicare overpaid $729M in EHR incentives
The report chided the CMS on its scant documentation reviews, which put the program at risk of abuse and misused funds.
By Meg Bryant • June 13, 2017 -
Centene goes rogue in expanding ACA exchange plans
Among news of other payers pulling out of the exchanges, the company says it is “well positioned” to expand services.
By Les Masterson • June 13, 2017 -
Deep Dive
DOJ sends warning shots on Medicare Advantage overpayments
Recent claims against UnitedHealth Group highlight the federal government's effort to recoup what it says is billions in overpayments.
By Les Masterson • June 13, 2017 -
FBI investigating Zoom+ for ACA risk adjustment fraud
The startup allegedly made members look less healthy, which meant it didn't pay as much for risk adjustment.
By Les Masterson • June 12, 2017
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