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CMS targets balanced billing in proposals for new marketplace guidelines

CMS is requesting comment on whether health plans should designate network strength, such as indicating whether a plan has a broad number of doctors or health facilities in the network or not. Read more »

Lack of claims rejection post ICD-10 may give 'false sense of security'

While CMS said it was "pleased to report that claims are processing normally," it's worth keeping in mind that the government agency has taken several temporary steps to smooth the transition to ICD-10 which may be masking problems that could manifest themselves down the road. Read more »

CMS ends bonus program aimed at addressing pay disparity between doctors, specialists

Many primary care practitioners will be a little poorer next year because of the expiration of a health law program that has been paying them a 10 percent bonus for caring for Medicare patients. Read more »

Medicaid denies 46 percent of pricey hepatitis C drug prescriptions, study finds

People with hepatitis C who sought prescriptions for highly effective but pricey new drugs were significantly more likely to get turned down if they had Medicaid coverage than if they were insured by Medicare or private commercial policies, a recent study found. Read more »

Over 40 percent of adults say their deductibles cause undue financial burden, report says

A new report by The Commonwealth Fund has found that a quarter of working-age adults struggle to pay for their healthcare in 2015 in the wake of rising deductibles and out-of-pocket costs. Read more »

Medicare-subsidized drug plans wane amid higher costs and insurance market consolidation

As beneficiaries explore options during the current Medicare enrollment period, there are only 227 such plans from which they can choose next year, 20 percent fewer than this year, and the lowest number since the drug benefit was added to Medicare in 2006, according to the Centers for Medicare & Medicaid Services. Read more »

UnitedHealth Group signals potential exit from Obamacare exchanges amid financial losses

UnitedHealth Group may exit the insurance exchange market, as the deterioration in product performance has weakened its financial outlook, the company said in an earnings update released Thursday. Read more »

Is UnitedHealth's marketplace exit the start of a trend for insurers?

Many said they anticipate the federal government will act to forestall widespread departures, particularly because continued withdrawals could be politically explosive during an election year. Read more »

Aetna, Anthem, Cigna stocks fell as UnitedHealth news dragged down Wall Street

A selloff of UnitedHealth Group stock on Friday pushed other major healthcare stocks lower following the insurer's warning that it may exit the Obamacare marketplace exchange business. Read more »

Aetna and Children's Hospital of Philadelphia form accountable care organization

Under the contract, the younger members of Aetna commercial plans in the five-county Philadelphia area and Burlington County, New Jersey, who receive care from The Children's Hospital physicians, became part of the program. Read more »

After appeal rejection, HAP Midwest Health Plan may sell denied areas of Medicaid membership

The State of Michigan on Tuesday denied a request by Henry Ford Health System's health plan to allow it to keep two regions, including Detroit, to its approved contract for the state's Medicaid program. Read more »

Amount of refund declines, but insurers still owe $2.4 billion in exchange rebates

Consumers have received more than $2.4 billion in Affordable Care Act premium rebates since 2011, but the number of people owed refunds by insurers decreased by more than a million this year compared to last, according to a report released Thursday by the Centers for Medicare and Medicaid Services. Read more »

More than 1 million sign up on HealthCare.gov during first two weeks of open enrollment

Week two of open enrollment saw another 500,000-plus consumers select plans in the federal marketplace, bringing the total for the first two weeks to over 1 million, according to the Centers for Medicare and Medicaid Services. Read more »

Humana gives $77 million bonus to physicians participating in value-based care

The goal is to increase the approximately 59 percent of Humana individual Medicare Advantage members who have primary care physicians participating in value-based relationships, to 75 percent by the end of 2017. Read more »

Obamacare open enrollment challenge leads advocates to seek out uninsured

To encourage more people to sign up in Florida, Obamacare assisters are handing out flyers at food truck festivals, farmers' markets and health fairs. Read more »

CMS invests $32 million to drive down number of uninsured children

The Centers for Medicare and Medicaid Services on Monday announced a $32 million initiative to drive down the number of uninsured children by supporting outreach to get families with children eligible for Medicaid and the Children's Health Insurance Program enrolled. Read more »

Bundled payments for knee and hip replacement to launch this spring

Under the model, hospitals in 67 geographic areas will receive additional payments if quality and spending performance are strong, or if not, have to potentially repay Medicare for a portion of the spending for care for a lower extremity joint replacement procedure. Read more »

McKesson's new rate pricing tool automates value-based reimbursement

The news comes as more health plans move from broad networks and straightforward reimbursement approaches to narrow networks and value-based payments. Read more »

CMS releases slight rise in Medicare Part A rates while keeping Part B unchanged

The Medicare Part A annual deductible that beneficiaries pay when admitted to the hospital will be $1,288.00 in 2016, a small increase from $1,260.00 in 2015. Read more »

First week of open enrollment sees 500,000 new plan applications

Over 1.1 million applications were submitted to HealthCare.gov from Nov. 1 through 7, CMS reported. Read more »

Health Republic Insurance co-op ordered to close by end of month as debt mounts

The nonprofit co-op Health Republic Insurance of New York owes hospitals within the Greater New York Hospital Association more than $150 million, according to a November 11 letter from President Kenneth Raske to member CEOs. Read more »

Horizon Blue Cross Blue Shield sued by St. Peter's for exclusion from OMNIA health plan

A judge in New Jersey is expected to hear a complaint by Saint Peter's University Hospital that it was illegally excluded from a new discounted health plan offered by the state's largest health insurer because it and other independent, Catholic hospitals serve low income residents, according to the health system. Read more »

AIDS and HIV patients get limited access to drugs on Marketplace silver plans, study says

In 31 states and the District of Columbia, silver-level plans cover fewer than seven of the 10 most common drug treatment options or charge consumers more than $200 a month in cost sharing, according to an analysis of 2015 silver plans by consultant group Avalere Health. Read more »

Senate committee and Justice Department scrutinizing dramatic drug price increases

The investigation is spurred by dramatic drug price increases, often on older, off-patent drugs, after the acquisition or merger of pharmaceutical companies. Read more »

Analysts take a wait and see approach to the long-term viability of provider-led insurance plans

Though healthcare systems can gain insurance know-how by partnering with or acquiring an insurer or third party administrator to handle claims, compliance and customer service, putting it all together can be challenging. Read more »

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