Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Medicare

Medicare Advantage Consumers Seek New Plans as Risk Scores Rise

by Thomas Beaton

Medicare Advantage (MA) consumers who switch to new health plans may have higher risk scores than beneficiaries who are content with their current options, indicates a Congressional Budget Office (CBO) report.   Payers who are...

AHIP Supports Demo of Medicare Advantage Plans as Advanced APMs

by Thomas Beaton

AHIP has voiced its support for a CMS demonstration project that would allow Medicare Advantage (MA) plans to qualify as Advanced Alternative Payment Models (APMs), the organization wrote in a statement to CMS. The payer advocacy group...

Providers Caught in Medicare Fraud Schemes Topping $200M

by Thomas Beaton

Law enforcement officials continue to crack down on Medicare fraud schemes that siphon millions of dollars from the programs, as individuals submit fraudulent claims or overcharge for unnecessary healthcare utilization. Federal law...

Emergency Response Devices Add Value to Medicare Advantage Plan

by Thomas Beaton

Anthem BlueCross BlueShield plans to add value onto consumer Medicare Advantage (MA) plans by offering personal emergency response systems (PERS) to beneficiaries, the payer announced in a series of press releases. MA beneficiaries in...

How the Medicare Advantage Market Can Offer Payer Opportunities

by Thomas Beaton

Medicare Advantage (MA) market data from A.M Best and the Kaiser Family Foundation reveals that the MA market has remained profitable and provides financial opportunity, but payers looking to enter into the market should expect to address...

Providers Seeing Even Mix of Public, Commercially Insured Patients

by Thomas Beaton

Providers are seeing a fairly even mix of Medicare, Medicaid, and commercially insured patients with fewer uninsured individuals than before the ACA, according to the AMA’s Physician Practice Benchmark Survey. In 2016, forty-three...

Medicare Consumers Prefer Phone Calls from Health Plans

by Thomas Beaton

Medicare consumers tend to prefer traditional phone calls or mailings over digital engagement strategies such as text messaging or using a member portal, according to a new Healthmine survey. Forty-eight percent of Medicare consumers aged...

Anthem Adds Home Meal Delivery to Medicare Advantage Plans

by Thomas Beaton

Anthem is offering home meal delivery service to its post-discharge Medicare Advantage plan members in  in several states including Georgia, Kentucky, Missouri, and Wisconsin the payer announced. Anthem is partnering with GA foods to...

Michigan MSSP Accountable Care Org Saves $8M for Medicare

by Thomas Beaton

The Physician Organization of Michigan Accountable Care Organization (POM ACO), a Medicare Shared Savings Program (MSSP) ACO, helped the state save $8 million dollars on Medicare expenses by reducing unnecessary ED utilization, preventing...

Top Commercial Payers Offering Medigap, MA, and Medicaid Plans

by Thomas Beaton

The top payers with the highest enrollment numbers for Medigap, Medicaid, and Medicare Advantage (MA) are a unique mix of some of the largest commercial payers as well as smaller to mid-size insurers, a new report from AHIP reveals. These...

CMS Releases 2018 Medicare Advantage Star Ratings for Health Plans

by Thomas Beaton

CMS has updated the 2018 Medicare Advantage star ratings on health plans, allowing consumers to explore options that will best suit their individual needs.   The star ratings are based on several consumer engagement and care quality...

Medicare Fraud Schemes Bring Jail Time, Admissions, Repayments

by Thomas Beaton

Medicare fraud is always a risk for such a large program, but federal crackdowns on waste, abuse, and improper payments are serving as a stern warning to providers who may be considering taking advantage of the system.   The Office...

Beneficiary Segmentation, Spending by Healthcare Payer Type

by Thomas Beaton

Healthcare spending in the US continues to grow steadily across all beneficiary segments and healthcare payers. 2015 data from CMS, the CDC, and the Kaiser Family Foundation (KFF) indicates that payers and individuals sponsoring their own...

Claims Analytics Help Medicare Identify, Prevent Provider Fraud

by Thomas Beaton

Close to a quarter of new Medicare fraud investigations started with the use of a claims analytics platform that has helped to save approximately $6.7 million in incorrect billings, a new GAO report found.   After reviewing fraud...

90% Medicare Supplemental Plan Members Report Satisfaction

by Thomas Beaton

Over 90 percent of Medicare supplemental plan beneficiaries cited satisfaction with their healthcare coverage, according to a recent AHIP study. Findings point out ways for payers to provide consumer-friendly health plans to a growing...

Nevada Blue to Offer Supplemental Medicare Coverage to Members

by Thomas Beaton

On October 1, Blue Cross Blue Shield (BCBS) of Nevada members can enroll in Medicare Supplemental Innovation Plans F, G, or N that provide preventative care services and extended benefits, the payer announced earlier this week. The plans...

Anthem to Acquire FL Medicare Advantage Organization HealthSun

by Thomas Beaton

Anthem entered into an agreement to acquire Florida-based HealthSun, a payer and integrated health system that provides care and coverage to 40,000 Medicare Advantage beneficiaries, the payer announced in a press release.   Leaders...

AARP: Congress Must Take Action on ACA Market Stabilization Solutions

by Thomas Beaton

In order to protect healthcare consumers and stabilize the ACA marketplace, Congress must pass legislation that creates affordable and accessible coverage options, protects Medicaid and Medicare program funding, and expands prescription...

NY Medicaid Inspector General Assists in $125M Fraud Takedown

by Thomas Beaton

The New York Office of the Medicaid Inspector General (OMIG) assisted the Medicaid Fraud Strike Force in uncovering Medicaid fraud totaled $125 million, the office announced in a press release. OMIG and the Strike Force helped other law...

AHIP: Permanently Renew Medicare Advantage Special Needs Plans

by Thomas Beaton

Congress should consider a permanent renewal of the Medicare Advantage Special Needs Plans (SNPs) because of the consumer protections they provide and their market implications, AHIP wrote in a letter to the House of Representatives. A...

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