Under the Patient Protection and Affordable Care Act’s medical loss ratio, health payers are required to spend a minimum of 80 percent of their premium revenue on paying claims and boosting...
MACRA legislation impacts a number of healthcare providers and entities including accountable care organizations (ACOs). Only a few Medicare accountable care organizations will actually be able to...
The health payer Humana released positive results within its Medicare Advantage program for the third year in a row, according to a company press release. The value-based care platform used at Humana...
Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a final rule that updates a number of reimbursement policies and rates under the Medicare Physician Fee Schedule (PFS), a CMS...
Among the payers facing a Department of Justice lawsuit against their health insurance mergers, Aetna and Humana have requested sanctions due to the government allegedly delaying the release of...
Vermont has been working on regulatory actions that would reform healthcare payment throughout the state specifically through an all-payer model. Last week, the Centers for Medicare & Medicaid...
While healthcare reform and legislation like the Affordable Care Act have brought medical coverage to an additional 20 million Americans across the country, the patient community still faces some...
Monthly premium costs on the Affordable Care Act exchanges is expected to rise an average of 25 percent in 2017, according to a report from the Department of Health & Human Services (HHS). This...
Among commercial health plans, Medicare Advantage, and Medicaid markets, approximately 25 percent of reimbursement is expected to be in the form of alternative payment models by the end of 2016,...
Multiple healthcare payers have been struggling with operating successfully on the Affordable Care Act’s health insurance exchanges. Some experts and lawmakers suggest that establishing a public...
At the end of September, the Government Accountability Office (GAO) announced in a briefing that the Department of Health & Human Services (HHS) does not have the authority to transfer funds from...
The Centers for Medicare & Medicaid Services (CMS) announced earlier this month in a press release that it will be awarding $300,000 to the Greater Flint Health Coalition (GFHC) so that more...
Dr. Patrick Conway, Principal Deputy Administrator and Chief Medical Officer at the Centers for Medicare & Medicaid Services (CMS), announced in The CMS Blog that 95 percent of all primary care...
One public health payer that has had a wide amount of controversy regarding its operations is Veterans Affairs. The latest controversy comes regarding the Veterans Affairs claim that it has new...
At the end of last week, the Department of Health & Human Services (HHS) released a final rule on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its policies on the new...
The Department of Health & Human Services (HHS) announced in a press release the discharge of the final ruling on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The MACRA...
In the healthcare industry’s move toward value-based care reimbursement, public and private payers create healthcare quality measures meant to align with how providers are paid and what type of...
The state of Vermont is moving forward with establishing an all-payer model that uses accountable care organizations and ensures a provider is reimbursed by an equal amount among all healthcare payers...
The Centers for Medicare & Medicaid Services (CMS) has improperly paid more than $9 million for Medicare services among 481 unlawfully present beneficiaries during the years 2013 and 2014,...
The states of Alabama, Michigan, and Texas will be able to test the Medicare Advantage Value-Based Insurance Design model beginning on January 1, 2018, according to a fact sheet from the Centers for...