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Medicaid spending soars 14 percent in expansion states, according to report

Medicaid spending soared nearly 14 percent last year--its biggest annual increase in at least two decades--as a result of millions of newly eligible low-income enrollees signing up under the Affordable Care Act, according to a report released Thursday by the Kaiser Family Foundation. Read more »

Shop around, CMS tells seniors ahead of Nov. 1 open enrollment, as Medicare drug prices rise

The monthly cost is increasing an average 26 percent for UnitedHealthcare's AARP MedicareRx Saver Plus while the First Health Value Plus plan is dropping an average 13 percent, according to an analysis of the 10 most popular drug plans by Avalere Health, a research firm. Read more »

Major insurers give their policies on reimbursing ICD-10 claims

While the Centers for Medicare and Medicaid Services announced a year's grace period this summer when it comes to claims coded with ICD-10, not all large commercial payers are following suit. Read more »

Health Republic Insurance is latest co-op to fail in ACA attempt to offer alternative to large plans

Due to concerns of insolvency, federal and state officials have ordered the nonprofit co-op Health Republic Insurance of New York to cease writing policies and to close by the end of the year. Read more »

New ACA definition allows small employers to continue as large group insurance plans

President Barack Obama signed legislation last week that makes a significant change in the health law's small business rules, following a rare bipartisan effort to amend the health law. Read more »

Increasingly, mobile payments simplify and speed-up billing process

Mobile payments solutions are gaining traction in the healthcare industry, according to experts, as the smartphone revolution takes root in American healthcare. Read more »

Timeline for Medicare payments tied to value-based care may be too ambitious, report says

A new report by the Health Research Institute of PricewaterhouseCoopers says the transformation from fee-for-service to value-based reimbursement will take longer than the ambitious timeline announced in January by Health and Human Services Secretary Sylvia Burwell. Read more »

Horizon CEO Robert Marino defends OMNIA Health Alliance before New Jersey Senate

Horizon Blue Cross Blue Shield of New Jersey's new ONMIA health alliance is under scrutiny from legislators in the state who want to delay the plan's rollout amid questions of how hospitals were chosen for the Tier 1 network. Read more »

Providers are thinking more like payers as industry moves towards population health

While payer-provider collaboration has long been important, new trends in managing population health data is strengthening that relationship as never before, according to MedeAnalytics CEO Andy Hurd, and in many ways it's changing how providers think. Read more »

Connecticut merger fizzles amid state budget cuts to Medicaid payments

"Severe and unexpected cuts" to Medicaid payments in the Connecticut budget have stalled talks of a joint venture between Hartford HealthCare and Day Kimball Healthcare, according to Hartford HealthCare. Read more »

Out-of-network providers charge on average 300 percent more than Medicare rate, AHIP says

Out-of-network providers charged patients on average 300 percent more than the Medicare rate for certain treatments or procedures, according to the analysis of 2013 and 2014 claims data released Thursday by the America's Health Insurance Plans. Read more »

Harvard Pilgrim partners with NH providers to create analytics company Benevera Health

New Hampshire hospitals Dartmouth-Hitchcock, Elliot Health System and Frisbie Memorial Hospital are joining with Harvard Pilgrim Health Care to create a new analytics company to manage the clinical and financial data across the organization. Read more »

Chronically ill pay twice as much for drugs on ACA exchanges than through commercial plans, study says

Chronically ill people enrolled in individual health plans sold on the Affordable Care Act insurance exchanges pay on average twice as much out-of-pocket for prescription drugs each year than people covered through their workplace, according to a study published Monday in the Health Affairs journal. Read more »

Capital access holds stable after King v. Burwell decision upholding subsidized health insurance premiums

While the Supreme Court decision in King v. Burwell that cleared subsidized health insurance premiums under the Affordable Care Act removed a lot of uncertainty from hospital finance, little has changed when it comes to hospitals' access to debt. But that may change. Read more »

Payers will have payment glitches under ICD-10, experts say

On Thursday, providers dealt with system issues, which will be followed by productivity issues and then payment issues, according to healthcare insiders. Read more »

True effect of ICD-10 rollout will be felt when claims are processed

Healthcare Finance spent the bulk of Thursday's rollout monitoring the buzz, speaking with experts and reporting on any issues that may have arrived. While the true effects of the change will be felt in the coming weeks when claims are processed, bills delivered and accounts receivable wane, we have a few observations to share. Read more »

CMS should increase oversight of Medicare health plans, GAO states

The federal government needs to increase its oversight over private Medicare health plans to make sure seniors have adequate access to doctors and hospitals, according to a report released this week by congressional auditors. Read more »

Insurers shortchanged $2.5 billion in CMS shared-risk corridor program

Insurance companies will pay $362 million to the federal government's shared risk program beginning this November for 2014 participation, but will be short $2.5 billion in payments that they hoped to receive from the federal government, the Department of Health and Human Services announced on Thursday. Read more »

Live ICD-10 updates: Get the latest news, reactions to the code change

Healthcare IT News and sister site Healthcare Finance will be reporting on the changeover throughout the day, using the live blog below to highlight the latest news, real-time reactions and frequent updates from our cadre of volunteer ICD-10 correspondents. Read more »

Federal court tells CMS hospitals must be able to comment on 0.2% payment cut in two-midnight rule

A federal judge has partly sided with providers in ordering the Centers for Medicare & Medicaid to provide further justification for the 0.2 percent payment reduction in provider compensation that will kick in under the two-midnight rule, according to the September 21 ruling in U.S. District Court in Washington D.C. Read more »

Federal government seeks out uninsured for ACA enrollment

The health law's upcoming enrollment period may be its toughest yet, with federal officials promising a vigorous outreach campaign to enroll millions of eligible yet hard-to-reach Americans who have yet to sign up for health insurance. Read more »

Value-based insurance design offers flexibility in supplemental benefits

The five-year model will be tested in seven states starting in January 2017: Arizona, Indiana, Iowa, Mass., Pennsylvania Tennessee and Oregon. Read more »

Aetna, Anthem CEOs tell Senate that mergers with Humana and Cigna won't stifle competition

Mark T. Bertolini, chairman and CEO of Aetna in Hartford, Connecticut and Joseph R. Swedish, president and CEO of Anthem in Indianapolis, argued before a Senate Judiciary subcommittee on Antitrust, Competition Policy and Consumer Rights on Tuesday that local insurance plans would keep the industry competitive. Read more »

Infographic: Top 11 Health Plans in 2015

The National Committee for Quality Assurance has released its newest rankings for health plans in the United States based on clinical and satisfaction scores.  Read more »

AHIP's Marilyn Tavenner jumps in on drug pricing, Hillary Clinton proposal

Earlier this week, Turing Pharmaceutical CEO Martin Shkreli drew sharp criticism after his privately held company boosted the price of AIDS treatment drug Daraprim from a reported $13.50 a tablet to $750. Read more »

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