Healthcare Finance Staff
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.
Following the devastation of post-tropical storm Sandy, the Centers for Medicare & Medicaid Services (CMS) issued blanket waivers of particular requirements that include all hospitals, skilled nursing facilities, home health agencies, hospice and end-stage renal disease facilities in the areas of New York and New Jersey that were strongly affected by the storm.
Proposals to allow for the sale of health insurance across state lines have long been touted as one way of effectively lowering the price of health insurance, particularly in states where there is a highly concentrated insurance market. The argument goes that resultant increased competition would encourage a state's existing health plans to lower prices in the face of the new market entrants.
Private health insurance exchanges are sprouting up and established ones want to grow, challenging state-based HIXs and expanding the retail insurance market. Insurers, in anticipation of the expected shifts in the marketplace, are positioning themselves in a big way to take advantage of this trend.
Massachusetts has tentatively selected six organizations to participate in a three-year, capitated payment model demonstration for dual eligible patients.
Humana Inc. on Monday announced third quarter 2012 earnings of $2.62 per share that were slightly lower than its earnings for $2.67 for the same period last year. Nonetheless, the company's third quarter performance beat both the company's internal guidance and bettered by a sizable margin Wall Street analyst estimates of $2.05 for the quarter.
With 20 percent of the state uninsured, Nevada's state exchange is aiming to offer affordable coverage and be financially self-sustaining, while neighboring California takes bids for its HIX, and insurers and state officials await a post-election rule-making flood from Washington.
The National Quality Forum (NQF) announced nov. 5 it has endorsed 10 behavioral health quality measures, addressing alcohol and tobacco abuse, antipsychotic medication adherence, and post care follow-up after hospitalization for mental illness.
The Government Accountability Office (GAO) has found that Medicare-covered advanced imaging services increased between 2004 and 2010, and that unecessary provider self-referrals cost $109 million in 2010.