Healthcare Payer News

Medicaid primary care reimbursement to get $11B boost from feds

As it looks to maintain Medicaid member access to primary care doctors, HHS announced last week a two-year, $11 billion program that will help states bring Medicaid payments for primary care services in line with those paid by Medicare.

GOP contends employers would save money under ACA by dropping health coverage

In the latest salvo against the Affordable Care Act, Ways and Means Committee Republicans published a report this week that contends employers would save money by dropping coverage for employees and shifting them to the state health insurance exchanges and paying the $2,000 per employee penalty for doing so.

Many hospitals anticipate dropped revenue due to ACA

With the future of the health reform law in the hands of the U.S. Supreme Court, a majority of hospitals and health systems are anticipating a drop in revenue as a result of the Affordable Care Act (ACA).

NQF endorses all-cause unplanned readmissions measures

The National Quality Forum (NQF) board of directors has endorsed two measures that address all-cause unplanned readmissions in hospitals -- an area of healthcare targeted for improvement given national imperatives to make healthcare safer, more affordable and keep people healthy.

Argument against ICD-10 delay doesn't focus on right points

Carl Natale, ICD10Watch.com

To be honest, I think we're beyond arguing the merits of ICD-10-CM/PCS implementation. It's inevitable.

The MLR Report: Just fiddling while Rome is burning

Robert Laszewski, Health Care Policy and Marketplace Review

The Kaiser Family Foundation estimates that 3.4 million people in the individual market will receive $426 million in consumer rebates because of the Affordable Care Act's new MLR rules. In the small group market 4.9 million enrollees will see $377 million in rebates, and 7.5 million people will get $540 million in the large group market. Wow!

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Research finds readmission rates linked to availability of care, socioeconomics

According to research that was presented last week at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2012, the differences in regional readmission rates for heart failure are more closely connected with the availability of care and socioeconomics rather than with hospital performance or a patient’s degree of illness.

HHS gives 6 more states $181M in HIX funding

The states of Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington will receive $181 million in grants from the Health and Human Services Department to help them establish health insurance exchanges.

No 'bubble' for healthcare IT, analysts say

Leading financial analysts scoffed at the notion of a healthcare IT “bubble” that could slow the pace of mergers and acquisitions this year. Speaking on a panel called “Financing The Deal” at the Nashville Health Care Council, they predicted that 2012 M&A activity would be brisk, though not superheated.

Maine company offers innovative wellness program to employees

Two companies in Maine have recently teamed up to provide an innovative and affordable healthcare plan to employees. The plan not only pays claims but also rewards those in good health with cash incentives.

N.Y. man defrauds Medicare of $70,000 in medical device reimbursements

Michael McKay, 32, of Saratoga Springs, N.Y.. pleaded guilty in district court on May 11 for forging physician’s chart notes to make Medicare or private carrier claims qualify for reimbursements for bone growth stimulator medical devices.

OIG pressures CMS on home health sanctions

As the number of home health agencies and fraud cases related to home health agencies continues to skyrocket, the Office of Inspector General (OIG) is exerting more pressure on the Centers for Medicare & Medicaid Services (CMS) to fulfill an obligation that is 15 years old.

Compensation incentive programs for healthcare professionals are ineffective

As the healthcare industry continues to move in the direction of using compensation incentives, a new analysis reveals that incentives as currently used are not an effective motivator for healthcare professionals and waste an estimated $20 billion in resources.

Not retiring at 65: Physician goes from anti-EHR to pro-ACO

Jeffrey Selwyn, an internist at New Pueblo Medicine in Tucson, Ariz., is 65, but he says he's nowhere near retiring. Unlike many docs his age who are throwing in the towel due to the increased pressures on physicians to use EHRs, Selwyn is excited. He wasn't always a fan, however.

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HIMSS Patient-Centered Payer Roundtable: mHealth and Payers -- The Evolution of Mobile Health Applications

The following is a summary of selected monthly meetings of the HIMSS Patient-Centered Payer Roundtable. Each session has a featured speaker and is focused on a specific topic. A session recordings of each meeting is available on the HIMSS Patient-Centered Payer Roundtable website.