Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

HealthPayerIntelligence News

Minn. Healthcare Payers Reported $687M in Financial Losses

by

Local healthcare payers in Minnesota reported financial losses of $687 million due to the rising gaps in premiums and healthcare spending. The Minnesota Council of Health Plans gathered statewide data from insurance companies and HMOs, and found...

Aetna Will Exit Iowa ACA Health Insurance Exchange in 2018

by

Aetna has announced that it will stop participating in the Iowa health insurance exchange in 2018, citing financial losses and market instability as primary reasons to exit.   "Earlier today we informed the appropriate federal and state...

ACA Risk Adjustment, Reinsurance Improved Payer Financials

by

A new study published in Health Affairs found risk adjustment and reinsurance provisions of the Affordable Care Act improved financial outcomes for certain payers with higher risk enrollees.   Researchers from AHRQ and CMS found that before...

House Committee Passes Bill with Healthcare Merger Implications

by

The House Judiciary Committee has voted 16-10 in favor of a bill that would revise and standardize part of the process of reviewing mergers for potential antitrust violations.   The Standard Merger and Acquisition Reviews Through Equal Rules...

CMS: Payers May See 2.95% Rise in Medicare Advantage Revenue

by

CMS announced updates to the Medicare Advantage (MA) program and Part D Prescription Drug Program, including an expected 0.45 percent increase in revenues for payers and the potential for up to 2.95 percent in revenue growth. “Medicare...

CHIP Funding Cuts Would Leave 8M Low-Income Kids Uninsured

by

More than 8 million low income children living with chronic diseases would lose healthcare coverage and incur higher costs if CHIP funding is not extended beyond 2017, says new research from the Yale School of Medicine. In a study published in...

Wellmark BCBS Latest to Exit ACA Health Insurance Exchanges

by

Wellmark Blue Cross Blue Shield, which operates in Iowa and South Dakota, will not renew or sell individual plans on the Affordable Care Act health insurance exchanges effective Jan 1, 2018. The decision follows three-year losses of approximately...

MA Medicaid Wrongly Paid $193M in Fee-for-Service Claims

by

An audit of MassHealth, the Massachusetts state Medicaid program, found the agency improperly paid approximately $193 million in fee-for-service claims for behavioral healthcare between 2010 and 2015.   Questionable payments to the Massachusetts...

BCBS of Minn. Cites Risk Pools for $322.4M in 2016 Losses

by

Blue Cross Blue Shield (BCBS) of Minnesota reported a net operating loss of $322.4 million in their 2016 financial audit, citing unbalanced risk pools and rising premium pricing as a current and future detriment to profitability. At the end of...

AHA Condemns CMS Rule for Medicaid Third-Party DSH Payments

by

The American Hospital Association expressed “deep disappointment” about a CMS final rule that will only include uncompensated care costs for covered Medicaid services in the calculation of hospital-specific DSH limits.   The...

California Legislature to Review Single-Payer Healthcare Bill

by

California lawmakers have introduced  a single-payer healthcare bill that would provide all Californians comprehensive coverage with minimal out-of-pocket costs. The State Senate will review SB 562, or “The Healthy California Act,”...

Prescription Drugs Account for 22% of Payer Premium Spending

by

Prescription drug costs consume the largest proportion of dollars spent on healthcare premiums, with 22 cents out of every dollar going to medication costs, says AHIP in a new data brief. Eighty percent of every dollar is spent on medical expenses,...

WI Improperly Claimed $3M in Medicaid Drug Reimbursement

by

Wisconsin’s Department of Health Services failed to correctly invoice providers for over $3 million in Medicaid drug reimbursement, says the Office of the Inspector General (OIG) in a new report, leading to improper reimbursement from federal...

CMS Extends Pediatric Alternative Payment Model Comment Period

by

CMS will continue to take public comment on its pediatric alternative payment model (APM) initiatives until April 7, 2017.   In March, CMS issued a request for information (RFI) related to establishing an APM specifically focused on the...

Kansas Lawmakers Vote for Medicaid Expansion Under the ACA

by

UPDATE: Kansas Governor Sam Brownback has vetoed the legislation, calling Medicaid expansion "irresponsible and unsustainable." Kansas state lawmakers in the House and Senate have voted to approve Medicaid expansion under the Affordable...

GAO Report: VA Benefits Appeals Process in Need of Reform

by

The Government Accountability Office (GAO) has identified notable inefficiencies in the VA benefits appeals process which have resulted in an average processing wait time of three years.   In its report on the issue, GAO also makes several...

Medicare Limitations on Diabetes Supplies Endanger Patients

by

Medicare’s Competitive Bidding Program (CBP) may increase the risk of negative patient safety events or medication nonadherence for diabetics by limiting the variety of available diabetes testing supplies, finds a survey by the American...

Anthem Appeals Cigna Merger with Cost, Quality Arguments

by

Anthem has opened an appeal in the U.S District Court citing opportunities for increased consumer savings and quality of care weeks after the DOJ blocked its planned merger with Cigna. Anthem argued that the DoJ’s ruling neglected a possible...

House Votes to Boost Health Insurance Options for Businesses

by

The House of Representatives has voted 236-175 to move the Small Business Health Fairness Act of 2017 to the Senate in an effort to increase health insurance options for small businesses. The Act is designed to promote the growth of Association...

House GOP Leaders Pull American Health Care Act Before Vote

by

Before it could reach the House of Representatives for a vote, Republican party leaders pulled the American Health Care Act (AHCA). Because lawmakers could not agree on the structure or substance of the conservative healthcare framework, the...

Continue to site...