Fierce Healthcare

FEBRUARY 22, 2024

This week, voters said they are worried about insurance premium costs in a new poll, Cigna invests nearly $10 million in 9amHealth, Waltz Health enters the Medicare market and more. Below is a roundup of payer-centric news for the week of Feb.19,

ACA 56

ACA Medicare Medicare 56

Fierce Healthcare

JULY 6, 2023

More than 52,000 low-income adults in Sout­­h Dakota are now eligible for Medicaid, the Centers for Medicare & Medicaid Services (CMS) and the U.S. | Low-income adults in South Dakota are now eligible for expanded Medicaid access under the Affordable Care Act, while 11 states hold out on approving the expansion.

Medicaid 56

Medicaid Medicaid ACA Medicare 56

Fierce Healthcare

SEPTEMBER 19, 2023

Troubled insurtech Bright Health must shell out about $380 million to the Centers for Medicare & Medicaid Services (CMS) over the next 18 months, according to a recent

ACA 60

ACA Medicaid Medicaid Medicare 60

Kaiser Health News

FEBRUARY 8, 2022

The penalties — a 1% reduction in Medicare payments over 12 months — are based on the experiences of Medicare patients discharged from the hospital between July 2018 and the end of 2019, before the pandemic began in earnest. Paradoxically, all those hospitals have five stars, the best rating, on Medicare’s Care Compare website.

Medicare 115

Medicare Medicare Hospitals COVID-19 115

Center for Health Insurance Reform

MARCH 31, 2023

The Affordable Care Act (ACA) recently celebrated its 13th anniversary with historic enrollment growth in the health insurance Marketplaces and the lowest-ever recorded uninsured rate.

Health Insurance 97

Health Insurance ACA Medicaid Medicaid 97

Fierce Healthcare

NOVEMBER 8, 2023

million operating loss in the third quarter as it continues to wind down its Affordable Care Act (ACA) business and navigates the sale of its Medicare Advantage | Bright Health Group posted a $462.8 Bright Health Group posted a $462.8

ACA 56

ACA Medicare Medicare 56

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 94

ACA Health Insurance Medicaid Medicaid 94

Healthcare IT Today

JULY 1, 2020

From Medicare Risk Adjustment (MRA) requests to HEDIS requests, Affordable Care Act (ACA) records retrieval, RADV, DRG Audit, CIP and QIP: the alphabet soup of chart request types […]. The following is a guest article by Steve Mallinak, Senior Vice President of Operations at Ciox.

ACA 98

ACA Medicare Medicare Hospitals 98

Jane Sarashon

FEBRUARY 27, 2024

In addition to highlighting the Patient’s Bill of Rights, NABIP’s keynotes and general sessions will speak to similar topics being brainstormed at VIVE this week — including mental health, maternal health, pharmacy and prescription drugs (pricing, PBMs), population health, and Medicare and Medicaid innovations.

ACA 118

ACA Prescription Drug Pricing Health Insurance Hospitals 118

Health Populi

JUNE 18, 2021

workers with private insurance more likely report poor access to health care, greater costs of care, and lower satisfaction with care versus people covered by public health insurance plans — whether Medicaid, Medicare, VHA or military coverage. Health Populi’s Hot Points: U.S. households.

ACA 139

ACA Health Insurance Medicaid Medicaid 139

HIT Consultant

FEBRUARY 6, 2024

Expanding Payer Reach and Expertise Based in Chicago with 160 experienced professionals, HealthScape offers comprehensive consulting services to payers across all segments, including commercial, Medicare, Medicaid, ACA, and federal.

ACA 52

ACA Medicaid Medicaid Medicare 52

Bill of Health

JANUARY 26, 2022

This policy would be particularly significant in states that have expanded Medicaid under the Affordable Care Act (ACA) , because justice-involved populations largely intersect with those made eligible for Medicaid in expansion states (namely, people who earn less than 138% of the federal poverty level).

Medicaid 293

Medicaid Medicaid COVID-19 Public Health 293

Healthcare IT Today

DECEMBER 22, 2020

CMS has released a proposed rule that will require Medicaid managed care plans and other insurers offering products on the ACA Exchanges to support the sharing of patient data amongst themselves.

ACA 145

ACA Medicaid Medicaid Medicare 145

Healthcare IT Today

FEBRUARY 21, 2024

Based in Chicago with 160 professionals, HealthScape helps payers across all segments, including commercial, Medicare, Medicaid, ACA, and federal, navigate the evolving healthcare landscape.

ACA 109

ACA Medicaid Medicaid Medicare 109

Healthcare IT News - Telehealth

AUGUST 29, 2022

Galileo first launched with in-home care for Medicare and Medicaid patients, creating a framework to include social determinants of health in clinical analysis and to bridge gaps in healthcare education. We currently power UnitedHealthcare's Virtual-First ACA Exchange plan in multiple states with more coming in 2023.

Telemedicine 155

Telemedicine ACA Medicaid Medicaid 155

MedTrainer

MAY 10, 2024

This process is vital for enhancing the accessibility and affordability of mental health services, aligning with the comprehensive healthcare coverage expansions under the Affordable Care Act ( ACA ). It can also be a prerequisite for enrolling with an insurance network or Medicare for the first time. Effective Jan.

Licensing 52

Licensing ACA Medicare Medicare 52

HIT Consultant

JANUARY 31, 2024

Expanding Access and Improving Quality Through this collaboration, both organizations aim to deliver high-quality care through value-based arrangements to patients with diverse insurance coverage, including Medicare, Medicaid, ACA Marketplace, and commercial plans.

ACA 52

ACA Medicaid Medicaid Medicare 52

HIT Consultant

NOVEMBER 22, 2021

Health Fidelity’s technology uncovers insights that enable better care planning and more complete revenue capture; giving health plans and providers the ability to succeed in risk-sharing arrangements across Medicare Advantage, Affordable Care Act (ACA), Medicaid, and Accountable Care Organization programs. Post-Acquisition Plans.

ACA 52

ACA Medicaid Medicaid Medicare 52

Healthcare Law Blog

JANUARY 26, 2023

Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat. The Medicaid and Medicare statutes also contain conscience provisions related to the performance of advanced directives, religious nonmedical healthcare providers and their patients.

ACA 105

ACA Medicaid Medicaid Compliance 105

Medisys Compliance

JULY 27, 2022

For dates of service on or after calendar year 2030, Medicare waives the coinsurance. In addition, the ACA amended Section 1833(b)(1) of the Act to waive the Part B deductible for screening colonoscopies, which includes moderate sedation services as an inherent part of the screening colonoscopy procedural service.

Medical Billing 52

Medical Billing Medical Billing Outsourcing ACA Medicare 52

The Health Law Firm

MAY 9, 2014

Board Certified by The Florida Bar in Health Law The Centers for Medicare and Medicaid Services (CMS) is enforcing fingerprint-based background checks for Medicare suppliers and providers designated as "high risk." Indest III, J.D.,

Medicare 40

Medicare Medicare ACA Medicaid 40

Bill of Health

FEBRUARY 10, 2023

Failing to anticipate litigation that challenges our efforts, such as with the ACA or the upcoming attempt to “codify Roe v. They brought at least five significant lawsuits designed to impede the Affordable Care Act, restricting the positive impact of the ACA’s Medicaid reforms and the use of the individual mandate.

Public Health 261

Public Health Health Care Reform ACA COVID-19 261

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. Coding and billing : All physicians and healthcare providers must maintain accuracy and avoid misconduct in all billing activities. name, phone number).

Regulatory Compliance 52

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

MedTrainer

JANUARY 12, 2024

Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. Affordable Care Act (2010): The ACA introduced the concept of value-based care, emphasizing quality and patient outcomes over quantity of services.

Compliance 52

Compliance HIPAA Telemedicine ACA 52

Healthcare Law Today

JANUARY 2, 2023

” The currently proposed provision has similar effect to the language CMS proposed in 2012 and, after consideration of comments, ultimately rejected in the 2014 Final Rule (Medicare Advantage and Part D) and 2016 Final Rule (Medicare Part A and Part B). The public has until 5 p.m.

Overpayments 52

Overpayments Overpayment ACA Medicare 52

Kaiser Health News

MAY 31, 2022

The former generally incurs no cost to patients under the ACA; the latter can generate bills. Remind your provider that the government’s interpretation of the ACA requires that colonoscopies be regarded as a screening even if a polyp is removed.

ACA 103

ACA Doctors Medical Billing Hospitals 103

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 101

Health Insurance ACA Medicare Medicare 101

Center for Health Insurance Reform

JUNE 14, 2024

This month we read about the effects of health risk assessments on Medicare Advantage payments, how the Affordable Care Act transformed the healthcare landscape in this country, and finally, about hospital pricing and the values of transparency. The days are heating up and so is the summer research!

Medicare 59

Medicare Medicare Hospitals ACA 59

HIT Consultant

SEPTEMBER 15, 2021

By integrating Talix’s technology with Edifecs’ signature Encounter Management solution, Edifecs will provide the opportunity for customers to operate risk adjustment processes more efficiently for Medicare Advantage, Managed Medicaid, and Affordable Care Act (ACA) products.

ACA 52

ACA Medicaid Medicaid Medicare 52

Healthcare IT Today

JULY 14, 2022

Is the algorithm in question used for Medicare, Medicaid, or ACA populations? Similar situations could arise around specific medical conditions where clustering around common environments for physically distant regions could provide higher volumes of data. Health coverage program.

ACA 140

ACA Hospitals Medicaid Medicaid 140

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. Stay up-to-date on all changes to regulatory requirements.

Compliance 59

Compliance Medical Billing Outsourcing Medical Billing ACA 59

Compliancy Group

JANUARY 3, 2024

The regulations surrounding medical billing compliance policy come from: Federal laws, such as the Health Insurance Portability and Accountability Act (HIPAA) and Affordable Care Act (ACA) State laws Medicare and Medicaid guidelines Health insurance policies Failure to comply with medical billing compliance regulations can result in: Fines, penalties, (..)

Medical Billing 52

Medical Billing Compliance ACA Health Insurance 52

MedTrainer

APRIL 8, 2024

Medicare Access and CHIP Reauthorization Act (MACRA): Promotes value-based care and rewards healthcare providers for quality and performance. Affordable Care Act (ACA): Ensures access to affordable healthcare and prevents fraud and abuse.

Compliance 52

Compliance Governance ACA HIPAA 52

Health Populi

JANUARY 9, 2020

For overall healthcare reform, the plurality of Americans prefer improving the current system (that is, building on the Affordable Care Act) versus repealing and replacing the ACA or adopting a Medicare for All plan.

ACA 77

ACA FDA Public Health Medicare 77

MedTrainer

JUNE 28, 2023

From sophisticated Medicare fraud to a rising prevalence of telehealth fraud , healthcare organizations need to be diligent in understanding these threats. The FCA prohibits submitting false or fraudulent claims for payment to government healthcare programs, such as Medicare and Medicaid. Anti-Kickback Statute (AKS).

Fraud 52

Fraud Compliance Governance Compliance Officers 52

Healthcare IT Today

JULY 18, 2023

The Centers for Medicare & Medicaid Services has expanded Medicare Advantage through 2023 to make the shift, and digital health tools are crucial for support. Additionally, rural patients often receive coverage from Medicare and Medicaid, limiting the providers they can access from an affordability standpoint.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Kaiser Health News

JANUARY 19, 2022

A spokesperson for the Centers for Medicare & Medicaid Services said in an email that the agency is not seeing a pervasive problem, but he declined to provide data on how often such cases occur or how the agents or brokers get the personal information needed to enroll unsuspecting people.

ACA 71

ACA Health Insurance Licensing Governance 71