Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Public Payers News

Texas Requests Medicaid Waiver Extension for $6.2 Billion

by

Although Texas refused federal funds in the 2014 ACA Medicaid expansion, it has recently submitted documents requesting its second Medicaid waiver extension for $6.2 billion.   Originally approved in 2011, the 1115 Medicaid...

CMS Uses Gender, Race For Quality of Care Medicare Study

by

The CMS office of Minority Health released a report with data on the quality of care received by Medicare Advantage (MA) enrollees by gender in four ethnic or racial categories.  The data generated by these reports was not used to...

Cigna Re-enters Medicare Advantage Market With CMS Approval

by

Cigna announced in a securities filing that it had received the green light from CMS to begin offering Medicare Advantage plans again after an 18 month suspension.  The insurer had been banned from offering the popular Medicare...

Flexibility and Innovation Needed To Control Medicaid Costs

by

As state and federal regulators debate the future of Medicaid spending, health researchers have identified the need for flexibility and innovation in Medicaid policies involving payment models, delivery of care and drug costs. The...

Medicaid Enrollment a “Lifeline” for Rural Residents, Children

by

Medicaid enrollment rates are highest for adults and children in small town and rural areas, providing a “lifeline” for low-income beneficiaries, according to a new analysis by the Georgetown University Center for Children...

3 Whistleblower Suits Net over $60 Million in Medicare Fraud

by

Whistleblower lawsuits alleging Medicare fraud have been settled against two diagnostic testing companies, and a California doctor who was alleged to have falsely diagnosed cancer as a means to bill Medicare for expensive...

ACA Medicaid Expansion Boosted Care Access, Patient Outcomes

by

Low-income adults taking advantage of the Affordable Care Act’s Medicaid expansion experience more financial stability and better outcomes, according to a new study from the Harvard T. H. Chan School of Public Health. “Our...

Two Payers Liable for $32.5M in Medicare Advantage Fraud Suit

by

Insurers Freedom Health and Optimum Healthcare have agreed to pay $32.5 million to avoid further litigation in a whistleblower lawsuit which alleges systemic Medicare Advantage fraud.    The insurers will pay the federal...

Single-Payer Healthcare Plan May Cost California $400 Billion

by

California’s proposed single-payer healthcare system would come with a $400 billion price tag, says a report from the state Senate on bill SB 562. The goal of the universal healthcare bill is two-fold: to tackle the issue of runaway...

Understanding the Basics of Accountable Care Organizations

by

Accountable care organizations (ACOs) are provider-based networks which utilize data analytics and population health management strategies to increase efficiency, improve patient outcomes, and reduce healthcare costs. Originally...

WI Medicaid Waiver Adds Drug Testing, Behavior Incentives

by

The Wisconsin Department of Health Services (DHS) will submit a section 1115 Medicaid waiver for the 2018 enrollment period that aims to add drug testing, healthy behavior incentives, and premium payments for certain beneficiaries. The...

CMS Adds Stricter Health Insurance Exchange Enrollment Rules

by

Slated to begin in June 2017, the Centers for Medicare and Medicaid Services (CMS) will be rolling out a pilot program aimed at tightening scrutiny of those using the special enrollment period on the ACA health insurance exchanges. The...

Two-Thirds of Physicians Disapprove of American Health Care Act

by

Two-thirds of physicians in a new Merritt Hawkins survey reported having a negative impression of the American Health Care Act (AHCA).  This includes 58 percent of physicians who have a “strongly” negative take on...

Cardiologists: Senate Must Ensure “Meaningful Insurance Coverage”

by

In a letter sent to Senate leadership, American College of Cardiology President Mary Norine Walsh, MD, advised lawmakers to ensure access to “meaningful insurance coverage and quality, cost-effective care” for the...

Maine Medicaid Waiver Would Increase Patient Responsibility

by

Maine will apply for a Section 1115 Medicaid waiver from the Centers for Medicare and Medicaid Services (CMS) to be granted flexibility to circumvent federal regulations and impose reforms on its Medicaid program. The state’s...

Patient Incentives from Payers Encourage Preventive Care Visits

by

To reduce payer claim costs, would you pay members to go see their doctor once a year?  That’s the premise for a wave of patient incentive programs currently being offered by health insurance companies. For healthcare insurance...

Medicaid Waiver Adds More Beds For Drug Addiction Treatment

by

To circumvent an obscure Medicaid requirement, seven more states applied to join California, Maryland, Massachusetts and New York to receive a Medicaid waiver to expand drug addiction treatment.   Current federal policy prohibits...

Are Health Insurance Subsidies Enough for Low-Income Patients?

by

Despite financial penalties designed to prompt consumers to keep their health insurance, current efforts to subsidize care for low-income individuals may not be enough to incentivize patients, according to a recent study by economists at...

Healthcare Orgs React to House Vote on American Health Care Act

by

The House vote to pass the American Health Care Act (AHCA) has drawn responses from across the healthcare industry.    The bill was passed 217-213, and immediately created a firestorm of commentary.  The passage of the...

AHIP Sees 28% Increase in Medigap Enrollment Among Seniors

by

AHIP has released data showing that enrollment in the Medicare Supplement, Medigap, has seen a steady increase from 2014 to December 2015.   The data represents statistics from 11.8 million enrollees with policies from 305...

X

Sign up for our free newsletter:

Our privacy policy


no, thanks

Continue to site...