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CMS Accountable Health Communities Model Stresses Social Needs

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This past January, the Centers for Medicare & Medicaid Services (CMS) announced a new funding opportunity for a program called the Accountable Health Communities (AHC) Model, which focuses solely on the social needs of Medicare and...

CMS Reveals 4 Options for Quality Payment Program Participation

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The Centers for Medicare & Medicaid Services (CMS) is working toward assisting healthcare providers in meeting some new regulations that are part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The meaningful use...

CMS Grants Navigators $63M to Boost Health Insurance Marketplace

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The Centers for Medicare & Medicaid Services (CMS) announced in a press release earlier this week that it will be providing $63 million in grants to both new and older organizations returning to offer health plans through the public...

Medicare Shared Savings Program Saved $466 Million in 2015

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The Centers for Medicare and Medicaid Services (CMS) announced last week the quality and financial results of the 2015 Medicare accountable care organizations. According to a press release from CMS, accountable care organizations operating...

CMS Bundled Payment Models Address Cardiac Care, Hip Surgeries

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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...

Aetna Leaving Health Insurance Exchanges Due to DOJ Lawsuit

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The latest news coming from the major health payer Aetna is its move to drop out of the majority of the health insurance exchanges it had been participating in this year. According to a press release from Aetna, it will leave most of the...

Affordable Care Act Payment Program Boosts Care, Cuts Costs

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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...

Aetna Cancels its Expansion in Health Insurance Exchange

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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...

Department of Justice Moves to Block Health Insurance Mergers

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While there have been talks of the Department of Justice (DOJ) looking to block the Anthem-Cigna and Aetna-Humana health insurance mergers by filing lawsuits, the final decision was announced today at a press conference. The DOJ will...

California’s Health Insurance Exchange Premiums May Spike 13%

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Premium rates on the state health insurance exchanges are expected to continue rising over the next year due to some of the provisions of the Affordable Care Act (ACA). Since the ACA has brought more coverage options and a greater number...

DOJ May File Lawsuits against Health Insurance Acquisitions

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The health insurance acquisitions between Anthem and Cigna along with Aetna and Humana is likely to be blocked by the Department of Justice (DOJ). According to the American Hospital Association (AHA), the Department of Justice will be...

President Obama Highlights Progress from Affordable Care Act

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When it comes to the Patient Protection and Affordable Care Act, the media has reported on a variety of opinions among healthcare experts and regulators regarding the benefits and disadvantages of the ACA. However, there has not been much...

17 Health Payers Participating in CMS Oncology Care Model

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The Centers for Medicare & Medicaid Services (CMS) is implementing a new payment and healthcare delivery system called the Oncology Care Model. This particular reimbursement program will involve multi-payer arrangements in which...

Republicans Release Plan to Replace the Affordable Care Act

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It is well-known the the GOP base has attempted to repeal the Patient Protection and Affordable Care Act for years since its passage. However, the big question that everyone has always wondered is what the Republicans would replace the...

CMS Awards $22M for Cost Transparency Under Affordable Care Act

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Last week, the Centers for Medicare & Medicaid Services (CMS) announced in a press release that $22 million of funds are available to help state regulators with issuer compliance according to consumer protections under the Affordable...

New Ruling in Medicare Shared Savings Program Changes Payment

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As previously reported, the Centers for Medicare & Medicaid Services (CMS) have finalized a ruling that changes how the Medicare Shared Savings Program operates its payment protocols among accountable care organizations. The change...

How State Policymakers Impact the Health Insurance Mergers

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In the state of Missouri, policymakers issued an order that would prevent the Aetna-Humana acquisition from proceeding in post-merger activity within Missouri's Medicare Advantage plans as well as some commercial health plans. The two...

Affordable Care Act Brought the Uninsured Rate to 9.1%

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The Patient Protection and Affordable Care Act has made a tremendous impact on healthcare coverage among Americans. An extra 20 million people now have healthcare access  do due to the health insurance exchanges. The Centers for...

How the SMART Act Resolved Medicare Secondary Payer Issues

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The Centers for Medicare & Medicaid Services (CMS) has released its final rule detailing a timeline for the expansion of the Medicare Secondary Payer Web portal, which must meet the requirements of the Medicare IVIG Access and...

Supreme Court Leaves Zubik v. Burwell Case to Lower Courts

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On Monday, the Supreme Court unanimously called for the lower courts to rule on the Zubik v. Burwell case and to find a compromise. This particular court case argues on whether employers, specifically religious nonprofit groups, should be...

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