Reimbursement

Healthcare providers are feeling the pressure to implement ICD-10 by the Oct. 1, 2014 deadline. With so much reimbursement money on the line, 65 percent of providers are looking to third-party consultants for help making the switch, said a recent report from healthcare market researcher KLAS.

In this week's HIX Digest: Tennessee Tea Party groups rally against a state-run HIX, the OPM proposes multi-state plan rules, New York aims for integrated eligibility systems and advocates wait for tobacco cessation coverage details.

Mark T. Bertolini, chairman, CEO and president of Aetna, delivered the opening keynote on Monday at the mHealth Summit. A former executive for Cigna, NYLCare Health Plans and SelectCare, he now oversees a global healthcare benefits company with some 33,000 employees in North America, Europe, Asia and the Middle East.

Last week New York Attorney General Eric T. Schneiderman announced a $3.1 million settlement with Excellus BlueCross BlueShield requiring the insurer to refund 12,000 plan members who overpaid their healthcare providers as a result of the company's improper accounting of deductibles.

Medicare Advantage (MA) HMO plans may be offering more efficient care than Medicare Part A and B plans, a study published in the journal Health Affairs has found. According to researchers, MA HMO enrollees have fewer hip and knee replacements and use fewer benefits for outpatient surgeries and procedures, inpatient stays and emergency department visits. 

Despite the economic downturn, the number of uninsured children eligible for Medicaid and CHIP programs fell to 4.4 million in 2010, a 10 percent decrease from the 4.9 million who were uninsured in 2008, according to an analysis of government data released recently by the Robert Wood Johnson Foundation.

Hospitals and healthcare systems across the country will soon be facing large cuts in Medicare if the U.S. Congress cannot reach an agreement on an alternative deficit reduction plan in order to avert the so-called fiscal cliff, therefore it's a good idea for these organizations to start being proactive.

Missouri governor pushes for Medicaid expansion; Kansas still awaits word from feds on KanCare overhaul; and New Jersey bill would limit insurers' ability to make reimbursement cuts in this week's Medicaid Digest.

The Federal Trade Commission (FTC) is challenging two hospital acquisitions, one in Ohio and another in Georgia that's currently under review by the U.S. Supreme Court, and the outcomes may establish precedent for post-health reform provider consolidation.

Increased adoption of consumer-directed health plans (CDHPs) and an increased emphasis on employee health management programs helped U.S. employers hold their health benefit cost increases to an average of 4.1 percent in 2012, the lowest average annual increase since 1997, according to a new survey from global consulting firm Mercer.