Payers

The Centers for Medicare and Medicaid Services has completed mailing new cards to the 61 million people covered by Medicare in the U.S., each with their own unique, randomly assigned Medicare Beneficiary Identifier (MBI). The old cards were based on each person’s Social Security number, the widespread access to which left individuals open to identity theft. When the plan was rolled out to the public last April, CMS said it would take a year for …

North Carolina’s state treasurer would like to see his state become the second in the country to align healthcare reimbursements with Medicare rates. The proposal is already being slammed by hospital systems and the North Carolina Healthcare Association on the grounds that any savings realized by the health plan and its members will come at the expense of overall quality of care across the state. However, Dale Folwell claims the plan he’d like to implement …

The pressure to demonstrate the value you provide to employers, compared with telemedicine, on-site clinics, and other venues for on-demand primary care, is increasing as employer health system networks continue to become more exclusive. An article posted recently by HealthLeaders suggests that employers and insurers believe tightening their provider selections will raise quality and cut costs. Regardless of whether that logic proves fruitful in the end, the result today is that provider networks are smaller. …

North Carolina’s Medicaid program has spent at least $75 million for patients to have nonemergency complaints addressed in the emergency room over the past couple of years. According to a new report released by the state, patients have to gone to the ED with primary complaints as mundane as bad breath, sunburn, bunions, and common warts. The report goes on to specify that those concerns—and many more—could be handled much less expensively and just as …

One out of every six patients who visit an emergency room could see denied claims—and a whopping hospital bill—if a retrospective review policy imposed by Anthem not long ago were adopted by other insurers. A study just published in JAMA Network found that 15.7% of ED visits by commercially insured adults could result in denial of the claim on the grounds that presenting symptoms were found to be nonemergent after the fact. The researchers considered …

The Centers for Medicare & Medicaid Services says it wants to stop paying hospital-based clinics more than they pay physician offices for the same level of care administered to Medicare patients. Calling it a “site-neutral plan for clinic visits,” CMS proposes lowering reimbursements for hospital outpatient departments to match what it pays on the physician fee schedule for clinic visits. According to figures released by CMS, right now Medicare pays roughly $116 for a visit …

An urgent care operator has accused Blue Cross Blue Shield of South Carolina of trying to restrict competition among urgent care centers by refusing to allow any new ones into its network in the Palmetto State—possibly due to a conflict of interest, they say. BCBS has called the anticompetition charge “an unfounded attack on the company’s integrity.” Nevertheless, state legislators Mike Burns and Bill Chumley see the urgent care operator’s point and have asked for …