Reimbursement

Value-based insurance design (VBID), conceived by a multi-disciplinary faculty team at the university of Michigan, works on the premise of aligning patients' out-of-pocket costs with the value of health services. As applied to benefit plan design, VBID recognizes that different health services have different levels of value.

ikaSystems, a provider of cloud computing technology for the payer market, and NASCO, which specializes in IT tools to support Blue Cross and Blue Shield Plans, have partnered to bring faster, more efficient and accurate Medicare processes to NASCO Plan customers.

Atlanta-based Gentiva Health Services, one of the country's largest providers of home health services, has agreed to pay $12.5 million to settle claims that it fraudulently billed Medicare for costs related to company sales efforts, announced the U.S. Attorney's office in Brooklyn.

The Department of Health and Human Services has launched the Federally Qualified Health Center Advanced Primary Care Practice demonstration project, an Affordable Care Act initiative that will pay an estimated $42 million over three years to as many as 500 health centers to coordinate care for Medicare patients.

Leaders of the Campaign for Better Care (CBC), a broad-based coalition of consumer organizations, recently submitted comments on the proposed ACO rule, commending the federal government for putting patients first.

Vermont is moving closer to starting a state-run health plan that would be able to insure nearly all of its residents.

The Centers for Medicare & Medicaid Services announced that it would no longer provide Medicaid reimbursements to hospitals and providers for injuries, illnesses or hospitalizations that could have been prevented. The announcement is in support of a provision within the Affordable Care Act that prohibits states from making payments to providers for "reasonably preventable" conditions.

Those of us who thought the healthcare reform debate would settle once the law was passed and regulations began to take effect may have been misguided.

Should brokers be compensated for helping consumers to enroll in government programs like the Pre-Existing Condition Insurance Plan (PCIP) created by the new healthcare reform law? Until now, the federal government’s answer has been “no.”