Healthcare Dive

JANUARY 31, 2023

America’s Health Insurance Plans lobby said the rule seeking to claw back billions of dollars from health insurers is unlawful and fatally flawed.

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Medicare Medicare Health Insurance 264

Healthcare Dive

AUGUST 8, 2023

UnitedHealth, CVS, Elevance and peers sidestepped the worst of medical cost growth in the quarter, but many payers face uncertainty from Medicare Advantage star ratings, GLP-1s and other pressures.

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American Medical Compliance

APRIL 17, 2024

The following Understanding Medicare Training educates healthcare providers and patients on the purpose of the Medicare program in the United States. Medicare is the federal health insurance program for people aged 65 or older, certain younger people with disabilities, and also people with End-Stage Renal disease.

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Medicare Medicare Compliance Health Insurance 52

Electronic Health Reporter

APRIL 27, 2023

This article is copyrighted strictly for Electronic Health Reporter. Medicare is a federal health insurance program in the United States that provides coverage to people 65 or older and some younger people with specific disabilities. Illegal copying is prohibited. appeared first on electronichealthreporter.com.

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Medicare Medicare Health Insurance 103

Healthcare Dive

JANUARY 24, 2024

The head of the Senate Finance Committee sent letters to several health insurance exchanges on Tuesday, as part of an inquiry into allegedly predatory Medicare Advantage marketing to seniors.

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Health Insurance Medicare Medicare 264

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.

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Health Insurance ACA Medicaid Medicaid 72

Modern Healthcare

MARCH 31, 2023

The Centers for Medicare and Medicaid Services estimates health insurance companies will see a 3.32% increase in Medicare Advantage revenue next year.

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Medicare Medicare Health Insurance Medicaid 80

HIT Consultant

NOVEMBER 8, 2021

Jessica Altman, Pennsylvania’s insurance commissioner sums it up well : “When we talk about bringing something back to state control, that is a real narrative that can appeal to both sides of the aisle. There is nothing political about making health insurance more affordable.”.

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Health Insurance Medicaid Medicaid Governance 98

HIPAA Journal

APRIL 21, 2023

Point32 Health, the second-largest health insurer in the state of Massachusetts, has announced it has experienced a ransomware attack that has resulted in system outages, including systems that are used to service its members, accounts, brokers, and providers. Tufts Health Plan members are not understood to have been affected.

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Health Insurance Ransomware HIPAA Medicare 57

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. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.

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Fraud Medicare Medicare US Department of Health and Human Services 52

Innovaare Compliance

FEBRUARY 5, 2024

Health Care Service Corporation (HCSC) has entered into a definitive agreement to purchase Cigna’s Medicare Advantage, Medicare Supplemental Benefits, Medicare Part D, and CareAllies businesses for $3.3 With Cigna’s Medicare plans serving 3.6 million members, HCSC will substantially increase its Medicare footprint.

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Medicare Medicare Due Diligence Health Insurance 52

Fierce Healthcare

APRIL 8, 2024

Health insurers are gearing up to release their first-quarter results over the next several weeks, and a new analysis from Fitch Ratings finds that ongoing concern about utilization in Medicare Adv | A new analysis from Fitch Ratings finds that ongoing concern about utilization in Medicare Advantage has made for a cloudy outlook.

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Medicare Medicare Health Insurance 115

Fierce Healthcare

APRIL 23, 2024

Medicaid managed care plans and the Children’s Health Insurance Program (CHIP) will be subject to new wait time standards and quality ratings requirements, the Centers for Medicare & Medicaid S | CMS defended implementing stronger rules over nursing home staffing as well as explained its thoughts behind Medicaid access and managed care rules.

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Health Populi

JUNE 26, 2023

People love being health-insured, but their negative experiences with health plans create serious burdens on patients-as-consumers. The 2023 Kaiser Family Foundation Survey of Consumer Experiences with Health Insurance updates our understanding of and empathy for insured peoples’ Patient Administrative Burdens (PAB).

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Health Insurance Doctors COVID-19 Medical Billing 62

Innovaare Compliance

FEBRUARY 5, 2024

Health Care Service Corporation (HCSC) has entered into a definitive agreement to purchase Cigna’s Medicare Advantage, Medicare Supplemental Benefits, Medicare Part D, and CareAllies businesses for $3.3 With Cigna’s Medicare plans serving 3.6 million members, HCSC will substantially increase its Medicare footprint.

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Medicare Medicare Due Diligence Health Insurance 40

The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

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Fraud Medicare Medicare Telemedicine 52

HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. Five state Medicaid programs, two Medicare Administrative Contractors, and two private health insurers were tricked into changing the bank account details for payments. million, and $6.4

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Medicaid Medicaid Medicare Medicare 81

Fierce Healthcare

MARCH 27, 2024

The Centers for Medicare & Medicaid Services (CMS) released a final rule Wednesday to help individuals obtain and retain Children's Health Insurance Program (CHIP) coverage. | In a final rule set to take effect in two months, CMS is streamlining its Medicaid and CHIP eligibility, enrollment and renewal processes.

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Medicaid Medicaid Health Insurance Medicare 111

Medisys Compliance

JUNE 7, 2022

Defining Medicare Secondary Payer (MSP). Medicare Secondary Payer (MSP) is the term generally used when the Medicare program does not have primary payment responsibility i.e., when another entity has the responsibility for paying before Medicare. When Medicare Pays First. Primary payers must pay a claim first.

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Medicare Medicare Medical Billing Medical Billing Outsourcing 59

Fierce Healthcare

DECEMBER 20, 2023

Among our most-read stories of the year, one topic clearly rose to the top: Medicare Advantage. Many of the most-read health insurance stories from Fierce Healthcare in 2023 center on Medicare Advantage.

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Medicare Medicare Health Insurance 115

The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

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Fraud Medicare Medicare Telemedicine 52

Health Law RX

FEBRUARY 21, 2024

The Centers for Medicare & Medicaid Services (CMS) has revised certain payment policies under the Medicare physician fee schedule, and updated provider and supplier enrollment regulations. CMS recently published a final rule (the Final Rule ) effective January 1, 2024. The stay ends on or before the 60th day of the stay period. “A

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Medicare Medicare Licensing Compliance 52

Compliancy Group

MARCH 8, 2023

are missing out on most of these opportunities because their names are on the HHS OIG (Health and Human Services, Office of Inspector General) Medicare Exclusion List. How the OIG Exclusion Database Came to Be HHS oversees the CMS (Center for Medicare Services), which administers the Medicare program.

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Medicare Medicare Fraud HIPAA 52

HIT Consultant

NOVEMBER 7, 2022

It provides a mark of distinction for healthcare and demonstrates the company’s commitment to quality, which means improved patient health outcomes.

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Health Insurance Compliance Officers Health Outcomes Compliance 98

HIPAA Journal

APRIL 29, 2024

Berry, Dunn, McNeil & Parker, LLC (BerryDunn) provides health data analytics services to healthcare providers, health insurers, and government regulatory and healthcare policy agencies and its clients provide BerryDunn with personal and health data to allow the firm to perform its contracted services.

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Health Insurance Health Analytics HIPAA Medicaid 99

Bill of Health

MARCH 27, 2024

Billing medical insurance for Spravato involves codes for both drug delivery and supervision because treatment requires administration of the drug (using the intranasal spray) and a monitoring period of at least 2 hours at a certified treatment center. Spravato is covered by Medicare Part B , which pays 80% of expenses.

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FDA Medicare Medicare Health Insurance 201

Center for Health Insurance Reform

DECEMBER 6, 2023

This week, the Centers for Medicare & Medicaid Services (CMS) is spotlighting how the Marketplaces can serve LGBTQI+ individuals, a community that has historically faced discriminatory barriers to health insurance and health care. It’s time to sign up for 2024 coverage on the Affordable Care Act’s Marketplaces.

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Health Insurance Medicaid Medicaid Medicare 82

Healthcare Law Blog

MAY 5, 2022

Department of Health and Human Services Office of Inspector (“OIG”) released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations (“MAOs”) (the “Report”). Thirteen percent of denied prior authorization requests met Medicare coverage rules. The OIG Report.

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Medicare Medicare Licensing Health Insurance 52

Health Populi

JUNE 5, 2022

Fast-forward through the 1990s and the advent of PBMs — pharmacy benefit management companies — the intermediaries managing drug benefits for health insurance plans. Today, the three largest PBMs, processing about 4 in 5 retail prescription claims, are embedded in large health insurance companies.

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Overpayments Overpayment Medicare Medicare 149

The Health Law Firm Blog

NOVEMBER 18, 2023

Board Certified by The Florida Bar in Health Law On June 15, 2022, the U.S. Supreme Court said the federal government improperly cut more than $1 billion a year in Medicare reimbursements to hospitals. Indest III, J.D., This came in a ruling that limits regulators’ power to control what the program pays for certain [.]

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Medicare Medicare Hospitals Governance 40

Fierce Healthcare

OCTOBER 2, 2023

SCAN Health Plan, a nonprofit health insurer specializing in Medicare Advantage (MA) offerings, is choosing to move faster than the government’s drug price negotiation timetable and is also offerin | SCAN Health Plan is launching a Medicare Advantage plan geared toward women and cutting 13 name-brand drug prices starting in 2024.

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Medicare Medicare Health Insurance 72

Center for Health Insurance Reform

FEBRUARY 10, 2022

Continue reading → The post January Research Roundup: What We’re Reading appeared first on Center on Health Insurance Reforms.

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Health Insurance Medicare Medicare ACA 74

The Health Law Firm Blog

AUGUST 23, 2022

Board Certified by The Florida Bar in Health Law On June 15, 2022, the U.S. Supreme Court said the federal government improperly cut more than $1 billion a year in Medicare reimbursements to hospitals. Indest III, J.D., This came in a ruling that limits regulators’ power to control what the program pays for certain [.].

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Medicare Medicare Hospitals Governance 52

Center for Health Insurance Reform

MARCH 7, 2022

Health insurers reported healthy earnings during the fourth quarter of 2021, thanks in large part to publicly funded programs Medicare and Medicaid. CHIR's Megan Houston reviewed earnings reports for nine major insurers and reports on the key market trends in the health insurance industry.

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Governance Health Insurance Medicaid Medicaid 72

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.

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ACA Health Insurance Medicaid Medicaid 133

Kaiser Health News

APRIL 16, 2024

Such private sector platforms, which must be approved by the Centers for Medicare & Medicaid Services, streamline enrollment by integrating with the federal ACA marketplace, called healthcare.gov. Some consumers were switched multiple times or had duplicative policies.

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ACA Health Insurance Governance Medical Billing 138

Fierce Healthcare

SEPTEMBER 22, 2023

For the past two years, we've convened industry leaders to dig deep into the health insurance sector's hottest market—Medicare Advantage—in a series of virtual forums. | We're bringing together top minds in the payer space at the inaugural Fierce Health Payer Summit, taking place on Nov.

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