Reimbursement
The Department of Justice has filed a civil antitrust lawsuit against Blue Cross Blue Shield of Michigan, alleging that provisions of its agreements with hospitals raise hospital prices, prevent other insurers from entering the marketplace and discourage discounts.
Massachusetts’ Connector, operational since 2006, is the prototype for PPACA’s insurance exchanges. Connector boosters have claimed it is a vital and successful part of Massachusetts’ health care reform; its critics have noted its failure to influence either benefit or administrative costs or to attract significant enrollment. However, whether success or failure, the Connector offers lessons for other states.
The Department of Justice has filed a civil antitrust lawsuit against Blue Cross Blue Shield of Michigan, alleging that provisions of its agreements with hospitals raise hospital prices, prevent other insurers from entering the marketplace and discourage discounts.
The nation could save about $3.5 trillion over the next 25 years by expanding coordinated care programs in Medicare and Medicaid, according to a new analysis by the UnitedHealth Group's Center for Health Reform & Modernization.
Washington State Insurance Commissioner Mike Kreidler has ordered Regence BlueShield to stop denying insurance coverage to children.
PPACA’s medical ratio loss rules continue to generate problems. Mini-med health plans, providing extremely modest coverage with low premiums, have been in the news this past week, with HHS’ announcement that plans offered by McDonalds and other low-wage employers will receive waivers from PPACA’s annual benefit limit provision to avoid potential termination of these plans.
HP Enterprise Services has been awarded a task order worth up to $26 million by the Centers for Medicare & Medicaid Services (CMS) to maintain its Integrated Data Repository (IDR) and provide data quality services to improve the accuracy of Medicare payment data.
Information technology and data mining capabilities had a role in dismantling what authorities are calling the largest Medicare fraud scheme ever, involving 73 members and associates of organized crime and more than $163 million in fraudulent billing.
A new survey shows that 84 percent of Medicare beneficiaries are satisfied with their coverage and more than 80 percent say their Part D premiums and co-payments are affordable.
The Centers for Medicare & Medicaid Services announced last month that the average premium for Medicare Advantage plans will be 1 percent lower in 2011.