Reimbursement
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.
Member enrollment also falls below projections, despite the jump in insured population nationwide.
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.
State officials had requested hospitals receiving payments and health plans reimbursing hospital providers to certify none of the contractual arrangements are above 120 percent of the Medicaid fee schedule, the allowable limit.
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.
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.
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.
CMS on Thursday said 360 organizations have directly entered into bundled payment agreements with the agency, and an additional 1,755 providers have partnered with those organizations as of July. But CMS acting administrator Andy Slavitt in June said there were more than 7,000 providers in the "at-risk" stage of the BPCI model.
As the clinical-financial relationship tightens, hospitals may want to consider whether they have appropriately organized their staffing roles and relationships to take the greatest advantage of the trend.
CenseoHealth accused of targeting those MAO plan members who were likely to yield the most serious diagnoses, and more likely to generate higher capitation payments.