Reimbursement
The December issue of Healthcare Finance News highlights the biggest stories our staff covered across the previous 12 months. And as has been the case for much of the past decade, many of the top issues deal with the tremendous changes impacting the healthcare industry.
With one open enrollment period closed and another beginning, HealthCare.gov and state exchanges have sold about 20 percent of the number of health plans that federal budget officials think is enough for a sustainable risk pool.
The California Department of Managed Health Care is trying to end the practice of emergency care "balance billing," just as thousands of new HMO members are being created.
After the disastrous launch of Obamacare the enrollment of 1.1 million people in the 36 state exchanges run by the feds is a major accomplishment. It is likely that the enrollment in the 14 state-run exchanges will take total Obamacare's private insurance enrollment to near 2 million for the year.
After several years on the decline, improper payment rates for Medicare and Medicaid increased in 2013, according to the government's estimates. How much of that represents fraud, though, still remains a mystery.
All the talk about moving healthcare reimbursement from volume to value sounds great, in theory. But how this shift takes place in practice is more complex than simply ending one form of payment and starting a new one.
As many as 1.5 million more Medicare beneficiaries now have access to coordinated care with the formation of 123 new accountable care organizations as of Jan. 1, the Health and Human Services Department has announced.
Physicians are getting a three-month reprieve from Congress. Included in the bipartisan two-year budget deal to fund the government is a delay until March of a scheduled 24 percent Medicare payment cut combined with a 0.5 percent pay increase. The president is expected to sign the legislation.
A Medicaid eligibility verification project has come to a partial stop in Illinois, amid one of the largest expansions in the program's history.
Bill Marshall, of Pega Healthcare Solutions, sees similarities between the problems faced by health insurance exchanges and tthe lessons learned by successful mHealth companies.