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Shared savings ACOs earn $341M in 2014

While many accountable care organizations in Medicare's Shared Savings Program generated enough savings in 2014 to merit financial incentives, more than two-thirds fell below the payment threshold, the Centers for Medicare & Medicaid Services said on Tuesday. Read more »

ACO operator says partners saved millions

Nine ACOs that partner with CHS generated $27 million in the Medicare Shared Savings Program. Read more »

Some reap big savings in Pioneer ACO program

Two Pioneer Accountable Care Organizations, Montefiore Health and the Banner Health Network, on Tuesday touted their success in generating savings for the Centers for Medicare & Medicaid Services ACO model. Though other organizations in the group found little reason to celebrate. Read more »

Amputees protest Medicare cuts to prosthetics

Amputees against proposed changes to Medicare coverage that would result in less expensive, but inferior, prosthetics being given to patients gathered in Baltimore Wednesday to ask officials to strike down the proposal. Read more »

Study: ACOs vary on spending savings

A new report published in the American Journal of Managed Care found that just over half of MSSP ACOs shared plans on how they'll allocate savings. Read more »

Study: 2M enrollees may miss reductions

More than 2 million people with coverage on the health insurance exchanges may be missing out on subsidies that could lower their deductibles, copayments and maximum out-of-pocket spending limits, according to a new analysis by Avalere Health. Read more »

Report: Eligibility logjams waste billions

MeriTalk report claims 11 percent of people who receive government healthcare benefits are not actually eligible. Read more »

Narrow network growth varies across states

Narrow insurance networks are gaining traction across the United States, as insurers have limited options for offering plans at different price points, according to a report by the Leonard Davis Institute of Health Economics and the Robert Wood Johnson Foundation. Read more »

Vendors: Prepare for ICD-10 disasters

Experts say problems seen in September in testing ICD-10 codes could turn into disasters when the new diagnostic code set goes live on October 1. Read more »

Fitch: Critical access hospitals safe ... for now

Though critical access hospitals will continue to earn less, Fitch Ratings this week said it does not expect the financial struggles to affect these hospitals' credit ratings due to their near 100 percent reimbursement from Medicare and political support that will stave off any attempt to cut payments. Read more »

Pennsylvania expands CHIP coverage

Pennsylvania families that faced penalties for Children's Health Insurance Program coverage that did not meet minimum requirements set by the Affordable Care Act are in the clear after Gov. Tom Wolf on Thursday said the state expanded its CHIP program. Read more »

Scott Walker pitches Obamacare alternative

Republican presidential candidate Scott Walker has released details of a healthcare model to replace Obamacare that would give tax credits to seniors to buy their own insurance. Read more »

Illinois Blue Cross adds ACOs

Blue Cross and Blue Shield of Illinois has developed accountable care organizations with three more provider-partners, bringing the total number of ACOs under the insurer to five, the insurer announced this month. Read more »

Doctor sentenced in $13M billing fraud

A doctor at a Brooklyn, New York, clinic was sentenced Friday to two years in prison for his role in a $13 million healthcare fraud scheme, according to the U.S. Department of Justice. Read more »

CMS end-of-life plan gathers opposition

Remember the so-called death panels? When Congress debated the Affordable Care Act in 2009, the legislation originally included a provision that would have allowed Medicare to reimburse doctors when they meet with patients to talk about end-of-life care. Read more »

Report: Billions wasted in verifying benefit eligibility

A new report shows $342 billion in taxpayer money is wasted each year in improper healthcare payments due to challenges in verifying benefit eligibility. Read more »

OIG: Most co-ops in the red

Most insurance plans established under the Affordable Care Act are losing money and may have difficulty repaying millions in loans, according to an audit report released by the Office of Inspector General. Read more »

Florida to audit 31 hospitals over managed Medicaid

Florida will audit 31 hospitals which failed to meet a deadline to certifying that their contracts with Medicaid managed-care plans comply with state law, according to Gov. Rick Scott's office. Read more »

Bundled payment partners drop off

More than 2,100 healthcare providers have passed through the review stage and will begin taking on financial risk in the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement Initiative, the federal agency announced on Thursday. Read more »

Questions surround out-of-pocket maximums

One of the health law's key protections was to cap how much consumers can be required to pay out of pocket for medical care each year. Now some employers say the administration is unfairly changing the rules that determine how those limits are applied, and they're worried it will cost them more. Read more »

How the Aetna, Humana merger played out

The merger between Aetna and Humana didn't come together overnight. In fact, based on a new Securities and Exchange Commission filing by Humana outlining the takeover, the deal stretches back to October 2014. Read more »

CMS delays risk corridor credits over bad data

The Centers for Medicare and Medicaid Services said it will delay releasing data on its risk corridor ratios for insurers participating in health insurance exchanges after it found several discrepancies in the data. Read more »

OIG finds tax credit verification issues with HealthCare.gov

Internal controls are lacking when it come to setting an individual's eligibility for tax credits and cost sharing reductions for health plans bought through Healthcare.gov, according to a new report by the Office of the Inspector General. Read more »

Poll: Will payer mergers stifle competition?

Two major deals that would result in top commercial insurance companies merging into their competitors has roiled the leadership of the American Hospital Association. Read more »

Experts: Medicaid has room to improve

The last and perhaps most controversial piece of health reform's universal coverage has many miles to go in terms of financial sustainability. But there are signs of progress. Read more »

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