Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Medicaid

Medicaid Can Increase Hospital Revenue Recovery by $500,000

February 14, 2019 - Hospitals could increase their revenue recovery from Medicare bad debt by as much as ten percent per year by identifying insured patients who are also eligible for Medicaid, according to a recent TransUnion Healthcare analysis.   This could translate to more than half a million in recovered revenue tied to both Medicare bad debt and Medicaid Secondary over a three-year period for...


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Medicare, Medicaid Best Private Plans for Containing Health Costs

by Jessica Kent

Medicare and Medicaid contain per enrollee health spending growth better than private insurance which likely indicates that recent policies will be key to sustaining this control, revealed a report conducted by the Urban Institute and...

PCPs, Psychiatrists Much Less Likely to Accept Medicaid

by Jennifer Bresnick

Primary care providers (PCPs) and psychiatrists are among the least likely professionals to accept Medicaid, leaving patients without some of the most fundamental resources for preventing or managing chronic diseases, according to recent...

Single Payer, Public Options Become Focus of Healthcare Debate

by Jennifer Bresnick

As the nation starts to turn its politics-weary eyes towards the 2020 election cycle, a new series of healthcare talking points are emerging, particularly from the left-hand side of the ideological spectrum. Terms like “single...

Walgreens Agrees to $296M Settlement in Healthcare Fraud Cases

by Jessica Kent

Walgreens has agreed to pay a total of $296.2 million in settlements for two separate healthcare fraud cases. The first settlement, approved on January 16, 2019, requires the pharmacy chain to pay $209.2 million to resolve allegations...

CMS Approves Arizona Medicaid Community Engagement Requirement

by Jessica Kent

CMS has approved Arizona’s request to add a community engagement requirement to its section 1115 Medicaid demonstration project, called “Arizona Health Care Cost Containment System” (AHCCCS). After consulting with Native...

Government Shutdown Spares Medicare, Medicaid, But Has Other Impacts

by Jennifer Bresnick

The partial government shutdown will have no impact on Medicare and Medicaid at the federal level, CMS has stressed to industry observers. The nation’s public payers will continue to operate as normal, since funding for CMS is...

CMS Proposes to Deregulate, Fast Track Medicaid Managed Care Programs

by Thomas Beaton

CMS has proposed a new rule to reduce regulation around Medicaid managed care programs and allow states to contract with private payers to deliver managed care at faster rates. CMS developed the rule in coordination with the National...

Poor Data Quality in CA Medicaid Drives $4B in Improper Payments

by Thomas Beaton

California's Medicaid program, Medi-Cal, made over $4 billion in improper payments to cover benefits for ineligible beneficiaries because of poor data quality and insufficient oversight, according to a new report from state...

Commercial, Managed Care Insurance Sectors Profits Boom in Q3

by Thomas Beaton

Commercial and managed care payers experienced significant third quarter profits, reductions in healthcare spending, and enrollment growth, according to the latest financial statements from insurance companies. Medicare Advantage (MA),...

CMS Grants NC 1115 Medicaid Waiver to Implement Managed Care System

by Thomas Beaton

North Carolina has received a 1115 waiver from CMS allowing the state to implement a Medicaid managed care system administered through private payers. The state’s Department of Health and Human Services (DHHS) can now recruit...

PBMs, Specialized Formularies Reduce Managed Care Prescription Costs

by Thomas Beaton

Pharmacy benefit managers (PBMs) with specialized drug formularies can help managed care payers significantly reduce prescription drug costs, according to new research published in the Journal of Managed Care and Speciality Pharmacy. The...

Engagement, Data Analytics Cut Opioid Dependency in Managed Care

by Thomas Beaton

AmeriHealth Caritas has successfully reduced opioid dependency rates among managed care beneficiaries through member engagement and data analytics techniques that promote alternatives to opioid treatments. The payer’s Opioid...

Administrative Plan Costs for Managed Care Payers Jumped 5.7% in 2017

by Thomas Beaton

Managed care payers experienced a 5.7 percent increase in administrative plan costs in 2017, for items such as staffing and customer service support, according to an analysis from the Sherlock Company. Spikes in Medicaid enrollment...

Medicaid Beneficiaries Face Significant Food Insecurity Challenges

by Thomas Beaton

Medicaid beneficiaries face significant food insecurity challenges and may require additional healthcare programs to reduce food insecurity risks, according to new research from the Root Cause Coalition. Many Medicaid beneficiaries...

Private Insurance Spending Has Outpaced Public Spending Since 2016

by Thomas Beaton

Private insurance spending has grown faster than Medicare and Medicaid spending since 2016, even though national enrollment has plateaued, says a new report from Altarum. The report suggests that higher per-enrollee spending, plus...

Managed Care Payers Struggle to Staff Long Term Support Services

by Thomas Beaton

Managed care payers and state Medicaid agencies are finding it difficult to find personnel to administer long-term support services (LTSS) within home and community-based settings (HCBS), says a new GAO report. Currently, Medicaid spends...

How Managed Care Payers Can Improve Substance Use Treatment

by Thomas Beaton

Managed care payers can use data analytics, case management strategies, and patient engagement tools to address the needs of high-risk individuals with substance use disorders (SUDs), states a new report from the Association for Community...

Medicare-Medicaid Dual Eligible Care Models Aim to Coordinate Care

by Thomas Beaton

Medicare and Medicaid dual-eligible care models provide extensive care coordination to ensure beneficiaries with multiple chronic conditions can access healthcare services, according to a new AHIP report.   Twelve million Americans...

1115 Medicaid Demonstrations Should be Budget-Neutral, CMS Says

by Thomas Beaton

CMS has issued new guidelines for state officials around creating budget-neutral 1115 Medicaid demonstrations. CMS informed state governments that the agency will use a formalized methodology to determine if 1115 demonstrations are a...

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