Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Primers

Risk Pool Gains on Horizon for Health Insurance Marketplace

by Vera Gruessner

With a number of healthcare payers including UnitedHealthcare and Aetna dropping out of the Affordable Care Act’s health insurance marketplace, the Centers for Medicare & Medicaid Services (CMS) issued an annual Notice of Benefit and...

35 Audits Find Medicare Advantage Plans Overbilling CMS

by Vera Gruessner

Audits conducted by the Government Accountability Office (GAO) reveal that up to 35 Medicare Advantage plans fraudulently billed the federal government for medical care provided to many of its elderly patients. The Center for Public Integrity...

Presidential Election Shakes Employer-Sponsored Health Insurance

by Vera Gruessner

Healthcare policy of US presidential candidates depends on more than their perspective on the Affordable Care Act. With employer-sponsored health insurance still a major aspect of coverage among Americans since fewer are insured through Medicaid...

Prescription Drug Medical Costs Less Problematic due to ACA

by Vera Gruessner

Recently, criticism popped up against the pharmaceutical company Mylan from the Hillary Clinton presidential campaign for its significant price increase for the life-saving EpiPen product. The EpiPen is vital in an emergency when a person who...

Patient Wait Times Still High at Veterans Health Administration

by Vera Gruessner

While there have been few major problems within the federal Medicare program that have led to any defamation of the federal agency, Veterans Affairs and, specifically, the Veterans Health Administration often has had its fair share of critics....

Two Contrasting Opinions on Accountable Care Organizations

by Vera Gruessner

The Patient Protection and Affordable Care Act isn’t merely responsible for creating health insurance exchanges, eliminating pre-existing conditions or even expanding the Medicaid program. The Affordable Care Act also helped build the Medicare...

CMS Bundled Payment Models Address Cardiac Care, Hip Surgeries

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) have recently begun implementing additional alternative payment models centered on episodes of care. CMS has proposed new rules for managing the costs of care and coordination among Medicare...

OIG: CMS Overpaid Colorado Medicaid Program More than $38M

by Vera Gruessner

The Office of the Inspector General discovered in an audit that the state of Colorado received millions of dollars in unallowable payments from operating the Medicaid Program and the Children's Health Insurance Program. The report from the...

Why Bundled Payment Programs Could Benefit Mammography Services

by Vera Gruessner

Bundled payment programs have been used in a wide variety of medical treatments and diagnostics such as joint replacement therapy and, more recently, cardiac care. The Centers for Medicare & Medicaid Services (CMS) has established these bundled...

Drop Outs in Exchanges, Health Insurance Merger Block Hit Market

by Vera Gruessner

The health insurance market seems to be heading toward more and more consolidation as the major payers Humana and Aetna along with Cigna and Anthem seem to be bent on merging, which would essentially reduce competition and create consolidation...

HHS Positions Bundled Payment Models Toward Cardiac Care

by Vera Gruessner

On July 25, the Department of Health & Human Services (HHS) announced further investment in bundled payment models within the healthcare industry. According to a news release from the Centers for Medicare & Medicaid Services (CMS), the...

Affordable Care Act’s Reinsurance Programs Keep Market Stable

by Vera Gruessner

One way that health payers can compete more effectively in the current destabilized environment is by investing resources in reinsurance programs. Reinsurance is a method in which a payer can buy a policy from other insurers in order to manage...

Affordable Care Act, Accountable Care Display Success

by Vera Gruessner

With fairly large sects of the political spectrum opposing various provisions of the Patient Protection and Affordable Care Act as many as six years after its passage, it grows vital to examine whether or not this landmark healthcare legislation...

Kentucky Governor Proposes Waiver for Medicaid Expansion

by Vera Gruessner

The status of Medicaid expansion has floundered around the nation ever since the Supreme Court ruled that individual states will have the option to choose whether or not to expand their Medicaid programs as called for under the Patient Protection...

Affordable Care Act Payment Program Boosts Care, Cuts Costs

by Vera Gruessner

The Patient Protection and Affordable Care Act has a wide variety of reforms that have been implemented to improve care for American citizens. One of these reforms includes a payment model called the Independence at Home Demonstration operated...

Affordable Care Act, Exchanges Challenge Health Payers

by Vera Gruessner

Ever since the passage of the Patient Protection and Affordable Care Act (ACA), a number of opponents have found factors to criticize within the landmark healthcare law. But has it truly brought more problems for the healthcare industry? From...

Is the ACA’s Health Insurance Provider Fee Unconstitutional?

by Vera Gruessner

Last year, six states including Texas, Wisconsin, Kansas, Louisiana, Indiana and Nebraska filed a lawsuit arguing that a provision within the Affordable Care Act requiring states to cover a Health Insurance Provider Fee is unconstitutional and...

Will Divestitures Preserve the Health Insurance Mergers?

by Vera Gruessner

As previously reported, the insurance companies Aetna and Humana are attempting to preserve their health insurance merger by divesting millions of dollars in assets in order to satisfy the concerns of the Department of Justice. David Balto, an...

Aetna Cancels its Expansion in Health Insurance Exchange

by Vera Gruessner

The national health payer Aetna continues to make headlines in the month of August after the public learned last month about the Department of Justice’s move to block Aetna’s major health insurance merger with Humana. On August 2,...

How Health Insurance Industry Faces the Presidential Elections

by Vera Gruessner

The upcoming US presidential elections may impact the future of the health insurance industry and the way healthcare costs are addressed in this country. Whether the Democrats or the Republicans take the White House, the continuing rise in the...

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