Reimbursement

In this week's HIX Digest, policy makers breath a sigh of relief after HHS extends the blueprint deadline; Republicans are still on the fence; and a new report looks at how the Massachusetts Connector impacted the small group market.

The U.S. Department of Health and Human Services on Friday extended the deadline for states to declare their plans for a state-based health insurance exchange for four weeks in order to accommodate governors who were awaiting results of the 2012 election to decide whether to move ahead.

Talks between West Penn Allegheny Health System and Highmark resumed Monday after a judge ruled last week that Highmark had not breached the $475 million merger deal, effectively barring West Penn from negotiating a new deal with other companies.

Now that the federal government is set to run Missouri's health insurance exchange, after voters passed a proposition banning state creation of an exchange without legislative or voter approval, lawmakers say they'd actually like to create their own.

North of the Mason-Dixon Line, it's hard to find a state that has given more of a cold shoulder to President Barack Obama's health law than Maine.

Brian Klepper comments on the American Academy of Family Physicians' recent moves to knock down the idea that nurse practitioners are equivalent to physicians for primary care. He mainly concedes their point -- after all family physicians have about quadruple the training of NPs -- but he's surprised that AAFP is training its sights on NPs rather than specialists.

The Everett Clinic and member-owned healthcare co-op Group Health Cooperative announced this week they would strengthen their existing relationship through an alliance that will create an accountable care organization to serve seniors in Group Health's Medicare Advantage plan.

Now that the election is over and the Affordable Care Act has been made permanent by the Supreme Court's decision, governors who have been sitting on healthcare decisions have "a lot of pent up energy" for moving forward, said former Republican Senate Majority Leader Bill Frist at a post-election healthcare meeting held in Washington, D.C., on Thursday.

With Medicare enrollment and spending set to grow in the coming decades, the program needs to better spread risk and incentivize value and also needs a better statutory definition of cost-benefit considerations, researchers argue in the latest issue of the New England Journal of Medicine.

Helping providers prepare for what some have called a coming reimbursement war, the tech firm SAI Global Compliance has unveiled an application called the "Claims Denial Manager," designed to limit losses from pre-payment claims denials.