Reimbursement
The Centers for Medicare and Medicaid Services is developing a new model for how it pays dual-eligible health plans after an analysis showed it was underpaying these plans.
Two-thirds of the 131 carriers that offered silver-level preferred provider organization plans in 2015 will either drop them entirely or offer fewer of them in January, and those cutbacks will affect customers in 37 states, according to the foundation.
Healthcare spending grew by 3.4 percent in 2014, a new report by the Health Care Cost Institute found, even though overall utilization declined.
The Massachusetts hospitals follow the exit of Dartmouth-Hitchcock Medical Center in New Hampshire last month.
The Centers for Medicare and Medicaid Services is developing a new model for how it pays dual-eligible health plans after an analysis showed it was underpaying these plans.
Two-thirds of the 131 carriers that offered silver-level preferred provider organization plans in 2015 will either drop them entirely or offer fewer of them in January, and those cutbacks will affect customers in 37 states, according to the foundation.
Republican said he would curtail the state's expansion of Medicaid by seeking a waiver for a more restrictive version of the program.
In the first part of this series, we looked at a transformative year in healthcare and presented the ongoing shift from the Risk Adjustment Processing System to the Encounter Data Processing System.
Here we present submission deadlines and what success does, and doesn't mean, so plans are not surprised when a high acceptance rate results in unexpected file rejections or a lower than estimated risk transfer or reinsurance payment.
In our last column, we took a look at how U.S. health plans operate in a world of rising expectations based on: value-based reimbursement; consumerization; healthcare cost management; and regulatory compliance.
In this second part of the series, we'll give the best strategic plan of attack for each of these four trends.
U.S. health plans today operate in a world of rising expectations. They must work to contain rising healthcare costs, while at the same time catering more to consumers as the ultimate users of their products, rather than solely satisfying the demands of employers.