Jane Sarashon

FEBRUARY 27, 2024

NABIP, whose members represent professionals in the health insurance benefits industry, drafted and adopted a new American Healthcare Consumer Bill of Rights launched at the meeting. Health Populi’s Hot Points: Is there an American Civil Right for health care?

ACA 113

ACA Prescription Drug Pricing Health Insurance Hospitals 113

Health Populi

JUNE 18, 2021

with employer-sponsored health insurance worry that a major health event in their household could lead to bankruptcy, according to research gathered by West Health and Gallup in Business Speaks: The Future of Employer-Sponsored Insurance. Health Populi’s Hot Points: U.S. One-half of U.S.

ACA 133

ACA Health Insurance Medicaid Medicaid 133

Center for Health Insurance Reform

OCTOBER 19, 2023

The annual open enrollment period for Affordable Care Act (ACA) Marketplace coverage kicks off November 1 in most states.

ACA 77

ACA Medicaid Medicaid Health Insurance 77

Bill of Health

NOVEMBER 9, 2023

America is the only wealthy nation to lack universal health coverage. Another reality is that even for those who have health insurance, the high costs associated with health care in the U.S. impede the right to health and contribute to disparities.

COVID-19 157

COVID-19 Public Health ACA Health Insurance 157

Center for Health Insurance Reform

NOVEMBER 9, 2022

At the end of the COVID-19 public health emergency, millions of people will lose Medicaid as states resume eligibility determinations. Continue reading → The post Bridging the Gap: Oregon’s Proposal to Ease Coverage Transitions at the End of Public Health Emergency appeared first on Center on Health Insurance Reforms.

Public Health 70

Public Health ACA COVID-19 Health Insurance 70

Center for Health Insurance Reform

MARCH 31, 2022

In the proposed Notice of Benefit and Payment Parameters for 2023, the Centers for Medicare & Medicaid Services asked for feedback on how to promote health equity through ACA marketplace operations and plan certification standards.

ACA 65

ACA Health Insurance Medicaid Medicaid 65

Center for Health Insurance Reform

APRIL 29, 2022

As many as 16 million people are expected to lose Medicaid once the COVID-19 public health emergency ends. One-third of these could be eligible for ACA marketplace plans.

Public Health 66

Public Health ACA COVID-19 Health Insurance 66

Center for Health Insurance Reform

APRIL 6, 2022

In addition to filling out our March Madness brackets, the CHIR team reviewed studies on health insurance rates during the pandemic, how the Affordable Care Act (ACA) impacted women’s health coverage, and consumer access to high-quality marketplace plans.

ACA 68

ACA Health Insurance COVID-19 Medicaid 68

Center for Health Insurance Reform

JUNE 12, 2023

April showers bring May flowers, and May was abloom with health policy research. Last month, we read about the impact of ending pandemic-related coverage policies, consumer awareness of the resumption of Medicaid renewals, and approaches to tackling rising health care costs in commercial health insurance markets.

Health Insurance 80

Health Insurance Medicaid Medicaid ACA 80

Center for Health Insurance Reform

MARCH 11, 2022

In honor of Black History Month, for the February edition of CHIR’s monthly research roundup we reviewed new health policy research centering the experiences of Black people in the U.S. Continue reading → The post February Research Roundup: What We’re Reading appeared first on Center on Health Insurance Reforms.

ACA 79

ACA Health Insurance Health Outcomes Medicaid 79

Center for Health Insurance Reform

NOVEMBER 13, 2023

In preparation for Health Policy Halloween, CHIR read up on the latest health policy research.

ACA 52

ACA Medicaid Medicaid 52

Compliancy Group

MARCH 19, 2024

Also, all insurance and Medicare or Medicaid claims must only include charges for services and treatments ordered and deemed necessary. Department of Health and Human Services (HHS) enforces laws relevant to patient care, healthcare delivery and billing, and workplace safety in the U.S. name, phone number).

Regulatory Compliance 52

Regulatory Compliance Compliance US Department of Health and Human Services ACA 52

Health Populi

SEPTEMBER 17, 2020

Census Bureau found that the level of health insurance enrollment fell by 1 million people in 2019 , with about 30 million Americans not covered by health insurance. The coronavirus pandemic has only exacerbated the erosion of the health insured population. lacked health insurance.

COVID-19 62

COVID-19 Health Insurance Public Health Health Care Access 62

Compliancy Group

FEBRUARY 12, 2024

Fraud in healthcare has run rampant in recent years, as evident by two incidents in which healthcare organizations billed insurance companies for things patients never received. Department of Health and Human Services, Office of Inspector General (HHS-OIG), said. Attorney Philip R.

Fraud 52

Fraud Medicare Medicare US Department of Health and Human Services 52

Healthcare It News

JUNE 3, 2022

Since California expanded health coverage under the Affordable Care Act, a large number of people have been mistakenly bounced between Covered California, the state’s marketplace for those who buy their own insurance, and Medi-Cal, the state’s Medicaid program for low-income residents.

Public Health 233

Public Health Health Insurance Professionals ACA Medicaid 233

MedTrainer

JANUARY 12, 2024

The adoption of electronic health records (EHRs), telemedicine , and data analytics has brought about new challenges and opportunities. Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. Compliance efforts expanded to encompass EHR security.

Compliance 52

Compliance HIPAA Telemedicine ACA 52

Healthcare Law Blog

JANUARY 26, 2023

The PHS Act requires post-graduate physician training programs that do not perform induced abortions to be deemed accredited and protects governmental payments provided as reimbursement for carrying out health related activities. Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat.

ACA 105

ACA Medicaid Medicaid Compliance 105

Kaiser Health News

JANUARY 19, 2022

” The changes are part of a 400-page proposed rule governing the federal health insurance marketplace and a few states that use the federal platform for their own exchanges. Under the ACA, sliding-scale subsidies are available to help low- and moderate-income people buy coverage.

ACA 72

ACA Health Insurance Licensing Governance 72

Compliancy Group

JANUARY 3, 2024

Medical billing compliance ensures that providers and administrators engage in ethical and accurate billing practices. It pays to know the law and avoid temptations to cut corners.

Medical Billing 52

Medical Billing Compliance ACA Health Insurance 52

Health Populi

MARCH 11, 2021

health care, patient assistance programs, Medicare Advantage plans, and the bundling of proven high-value preventive services into the Affordable Care Act. These services are enumerated in Section 2713 in the ACA , prompting Dr. Kavita Patel to assert in the first panel of the day that, “2713 is my favorite number.”

Health Insurance 98

Health Insurance ACA Medicare Medicare 98

Health Populi

JUNE 22, 2022

The last chart from the Commonwealth Fund 2022 State Scorecard talks about the rate of uninsurance by state — think ZIP code or personal GPS — calling out the fact that a dozen Governors did not expand Medicaid to accommodate ACA health plan enrollment for their health citizens.

COVID-19 112

COVID-19 ACA Public Health Health Outcomes 112

Healthcare Law Blog

MARCH 20, 2023

1] In addition to the challenges presented by provider shortages, even when patients are able to locate an available mental health provider, many are hesitant to engage in treatment due to cost uncertainties, which often arise due to limited availability for in-network care and the subsequent need to seek out-of-network care. [2]

Medicaid 52

Medicaid Medicaid Licensing ACA 52

MedTrainer

JUNE 28, 2023

The FCA prohibits submitting false or fraudulent claims for payment to government healthcare programs, such as Medicare and Medicaid. The Stark Law prohibits physicians from referring Medicare or Medicaid patients to entities with which they have financial relationships, unless specific exceptions are met. Anti-Kickback Statute (AKS).

Fraud 52

Fraud Compliance Governance Compliance Officers 52

Medisys Compliance

NOVEMBER 6, 2023

Compliance with Regulatory Guidelines Ensure that all claims are submitted per all applicable laws and regulations, including the Health Insurance Portability and Accountability Act (HIPAA), the Affordable Care Act (ACA), and the Medicare Fraud, Waste, and Abuse (FWA) laws.

Compliance 59

Compliance Medical Billing Outsourcing Medical Billing ACA 59

Center for Health Insurance Reform

DECEMBER 12, 2022

As part of CHIR’s weekly installment of FAQs from our updated Navigator Resource Guide, we highlight questions about the marketplace and reproductive health care. Continue reading → The post Navigator Guide FAQs of the Week: Coverage of Reproductive Health Care appeared first on Center on Health Insurance Reforms.

Health Insurance 50

Health Insurance ACA Medicaid Medicaid 50

Medisys Compliance

APRIL 25, 2023

It is crucial to verify that the billing company is adhering to industry standards, such as HIPAA (Health Insurance Portability and Accountability Act) regulations, which protect patients’ medical information.

Regulatory Compliance 52

Regulatory Compliance Compliance Medical Billing Outsourcing ACA 52

MedTrainer

MARCH 28, 2024

Law by law, regulations were added, increasing the complexity of maintaining compliance for healthcare organizations.

Compliance 52

Compliance Compliance Officers Licensing Regulatory Compliance 52

YouCompli

AUGUST 9, 2023

From a compliance perspective, this means supporting care teams based on the principles of social determinants of health (SDOH), such as understanding how to access affordable health insurance or obtaining transportation for follow-up appointments.

Compliance 52

Compliance COVID-19 ACA Fraud 52

Health Populi

FEBRUARY 23, 2018

workers were enrolled in a high-deductible health plan in the first 9 months of 2017, according to the latest research published by the National Center for Health Statistics, part of the Centers for Disease Control in the U.S. Department of Health and Human Services. Over four in 10 U.S. million Americans in 2017.

Health Insurance 79

Health Insurance Medicaid Medicaid Doctors 79

Health Populi

SEPTEMBER 5, 2018

The largest patient experience workflows included shopping for health insurance, preparing to see a healthcare provider, connecting with that provider, managing a diagnosis, shopping for services, receiving treatment, and finally, paying for the services. At this moment in U.S.

Health Insurance 63

Health Insurance Medical Billing Medicaid Medicaid 63

Healthcare IT Today

APRIL 10, 2023

The only way to actually change health behaviors—and therefore health outcomes—is by creating motivation on an individual basis. Behavioral Economics at the Core We partner with health insurers and providers to set up a monthly reward system that’s built on behavioral science, utilizing concepts such as loss aversion.

Health Outcomes 95

Health Outcomes Hospitals ACA Doctors 95

Health Populi

NOVEMBER 19, 2019

In research from HealthPocket , 2 in 5 Americans said they needed to reduce other household expenses to be able to afford their monthly insurance premiums. Four in ten consumers said their monthly health insurance premiums were increasing. Health insurance costs increased a whopping 20.1%

Health Insurance 68

Health Insurance Hospitals Nurses Doctors 68

Healthcare Law Blog

MARCH 25, 2022

Various smaller health insurance issuers have challenged the risk-adjustment program under the Patient Protection and Affordable Care Act (ACA), alleging, among other things, that its underlying methodology favors larger insurers. Once the new rules were published, Vista Health Plan, Inc., 2018 Final Rule, 83 Fed.

ACA 52

ACA US Department of Health and Human Services Health Insurance Medicaid 52

Healthcare Law Blog

APRIL 6, 2022

On April 1, 2022 , the Centers for Medicare & Medicaid Services (“CMS”) announced states may seek to extend Medicaid postpartum coverage from 60 days to one year through a new state plan option offered by the American Rescue Plan Act (“ARPA”). In states that have not expanded Medicaid, however, many postpartum women lose coverage.

Medicaid 52

Medicaid Medicaid ACA Public Health 52

Healthcare Law Blog

DECEMBER 15, 2022

The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule , “Advancing Interoperability and Improving Prior Authorization Processes” (the “Proposed Rule”), that is intended to improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Bill of Health

FEBRUARY 27, 2023

This pervasive structure for public health and health care laws caused problems before the New Roberts Court, but COVID-19 politics highlighted the degree to which state officials are turning away from partnering and toward what I call the “state veto.” It would also offer some defense against clear statement rules on steroids.

Public Health 246

Public Health COVID-19 Medicaid Medicaid 246

CMS.gov

MARCH 6, 2013

By: Christine Stahlecker, Director, Administrative Simplification Group, Office of E-Health Standards and Services, Centers for Medicare & Medicaid Services. These requirements are in place to lower costs, create uniform electronic standards, and streamline exchanges between health care providers and payers.

ACA 30

ACA HIPAA Medicaid Medicaid 30