Reimbursement

Triple-S Management Corporation has agreed to settle potential HIPAA violations with the U.S. Department of Health and Human services to the tune of $3.5 million, after repeatedly failing to put safeguards in place for its beneficiaries' PHI.

The boundary between being a provider and a payer is blurring as hospitals face more risk, according to Joe Nichols of Health Data Consulting, prompting health systems to make changes to keep from losing too much money.

The U.S. Senate on Thursday approved a bill repealing the bulk of the Affordable Care Act in a vote of 52 to 47 that largely went along party lines.

CMS said by the end of next year, 85 percent of all traditional Medicare payments to quality or value and 30 percent of traditional Medicare payments should be tied to alternative payment models.

The case hinges on Vermont legislation requiring all administrators of self-insured benefit plans to regularly submit data on medical claims, pharmacy claims, member eligibility, provider and other information for use in the state's unified healthcare database.

Healthcare juggernaut Kaiser Permanente announced Friday they have inked a deal to acquire the Seattle-based Group Health Cooperative in a deal that will expand Kaiser's reach by roughly 509,000 members and add an entirely new region of coverage.

Though the outgoing governor of Kentucky and other supporters of the president's Affordable Care Act have been critical of a pledge made by incoming governor Matt Bevin to abolish the state exchange in favor of switching to the federal marketplace, his plan may have little effect on consumers.

One in three family physicians are actively pursuing a move to value-based payment and an additional 19 percent are developing the capabilities for it, a new study sponsored by Humana and conducted by the American Academy of Family Physicians has found.

Though the outgoing governor of Kentucky and other supporters of the president's Affordable Care Act have been critical of a pledge made by incoming governor Matt Bevin to abolish the state exchange in favor of switching to the federal marketplace, his plan may have little effect on consumers.

Forty-five percent of the silver-level PPO plans coming to the market for the first time in 2016 provide no annual cap for policyholders' out-of-network costs, an analysis by the Robert Wood Johnson Foundation finds.