Reimbursement

Medicaid managed care plans run by publicly traded, for-profit insurers have higher administrative costs and lower quality of care, according to a brief released last week by the Commonwealth Fund.

The government has found a new high-tech way to crack down on fraud in the Medicare program – predictive modeling. The Centers for Medicare & Medicaid Services (CMS) said last week the initiative would start on July 1.

Wisconsin's budget bill passed earlier this week drops a provision for public hearings to be held in advance of any cuts to BadgerCare, the state's Medicaid program. The move comes as the state is looking to trim nearly $500 million from BadgerCare as part of the state's effort to balance the budget.

Overall U.S. healthcare prices continued to rise slowly, increasing 0.1 percent from April 2011 to May 2011, according to the federal Bureau of Labor Statistics.

The Council For Affordable Quality Healthcare's Committee on Operating Rules for Information Exchange (CAQH CORE) will collaborate with the National Council for Prescription Drug Programs (NCPDP) on activities related to harmonizing electronic data interchange standards and operating rules across healthcare.

A majority of medical groups have not completed critical software upgrades for transition to HIPAA Version 5010 electronics standard, nor have they scheduled testing with health plans, according to follow-up research by the Medical Group Management Association (MGMA).

Aetna has agreed to buy the Medicare supplement and related blocks of in-force business of Genworth Financial for $290 million.

The American Health Information Management Association (AHIMA) Foundation has announced it is initiating the Health Information Relief Operation (pronounced "Hero") Fund as an ongoing recovery source to assist health information management (HIM) professionals whose lives have been shattered by natural or man-made disaster.

Fallon Clinic has announced that 96 percent of its doctors have achieved meaningful use. The clinic has been selected by HIMSS as a finalist for a 2011 Ambulatory Care Davies Award of Excellence.