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.

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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.

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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.

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Healthcare IT Today

JANUARY 14, 2025

Medicare Advantage (MA) will likely see expanded backing, further solidifying its role as a cornerstone of value-based care. While there may be concerns regarding the Affordable Care Act (ACA), its survival seems likely given its established infrastructure and widespread reliance.

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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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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.

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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.

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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. United States Dep’t of Health & Hum. 20-50963, 2022 WL 807554, at *1 (5th Cir. The Risk-Adjustment Program.

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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.

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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

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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.

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Compliancy Group

FEBRUARY 12, 2024

In one incident, a New Jersey pharmacy admitted to conspiracies to defraud benefits providers, including Medicare and Medicaid, of $65 million for medications never provided to patients. 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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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,

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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.

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Center for Health Insurance Reform

SEPTEMBER 30, 2024

This month we read about the growing divergence between Medicare Advantage bids and payments, the impact of enhanced premium tax credits by race and ethnicity, and about how narrow or broad ACA marketplace physician networks really are. More hot days mean more hot research!

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Healthcare IT Today

JANUARY 16, 2025

$17M Series B Round Led by Aquiline to Fuel Scriptas Growth into Health Plan and Medicare Advantage Markets Consumerism in healthcare is a popular catchphrase, but when it comes to prescription drugs, Americans are lacking the transparency, clinical expertise, and navigation tools needed to make informed decisions.

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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

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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.

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Health Populi

APRIL 3, 2023

Social Security, Medicare, and Medicaid all garner most partisans’ support whether identifying as Democrat, Independent, or Republican, KFF found in their monthly poll of U.S. Most health citizens, cross party affiliation, are worried about the future of Medicare. A majority of the U.S. voters ages 18 and over.

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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.,

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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.

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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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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.

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Bill of Health

APRIL 13, 2022

After the PHE, states can facilitate smooth transitions for those no longer eligible for Medicaid by taking advantage of the full 12- to 14- month period that the Centers for Medicare & Medicaid Services (CMS) has established for redetermining eligibility.

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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.

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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.

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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.

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Health Populi

APRIL 2, 2018

Today, fewer than 1 in 2 people are confident in their ability to get needed treatments; this falls to one-third of people in the next decade, and only 1 in 4 people once eligible for Medicare.” Given the frailty of the ACA health insurance marketplaces (which was not addressed in the recent Congressional budget deal , much to Sen.

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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.

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Health Populi

FEBRUARY 6, 2020

isn’t repealing or replacing the Affordable Care Act or moving to a Medicare-for-All government-provided plan. Improving Medicare. modernizing the Stark Law and Anti-Kickback Statute, modifying Medicare Part D drug benefits to cap out-of-pocket spending, and other items), and to improve Medicaid. Improving Medicaid.

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Hall Render

JANUARY 10, 2025

On January 1, 2025, the Centers for Medicare and Medicaid Services’ (“CMS”) new 60-Day Rule became effective. 180-Day Suspension Period The ACAs initial enactment of the 60-Day Rule required reporting and returning of overpayments within 60 days of discovery. Failure to comply can result in liability under the FCA.

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The Health Law Firm

JANUARY 29, 2015

However, for the past two years, Medicaid programs have been required to reimburse primary care providers at Medicare levels, which is typically higher. The rate increase was part of the Affordable Care Act (ACA) as an incentive for providers to participate in Medicaid. However, that rate increase expired December 31, 2014.

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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.

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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.

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HIT Consultant

DECEMBER 20, 2021

This will make hundreds of thousands more Medicaid, Medicare Advantage, and ACA exchange health plan members eligible for the holistic, culturally competent services offered by the Equality Health care model.

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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.

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Health Populi

JUNE 2, 2021

At the same time, they were not as satisfied with their health care as people enrolled in Medicare or a VA/military health plan. As the last chart from the JAMA study illustrates, patients covered by employer sponsored care tended to land on the higher side of having medical debt.

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