Practice Management
The Affordable Care Act—also known as the ACA, or “Obamacare”—famously drove many insurers out of state exchanges due to the difficulty they had in turning a profit through their participation. President Trump says the plan he’d like to see in place would be both superior and less expensive than his predecessor’s. Humana isn’t planning on sticking around to find out, however, and has announced it will not be participating in any individual insurance market after …
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The Centers for Medicare and Medicaid Services’ plan to transition from a Social Security number-based ID system to a randomly generated identifier is moving forward. The agency won’t start mailing new cards until April 2018, and the whole process will take nearly 2 years to complete, but in the meantime CMS is rolling out a provider- and patient-awareness campaign to assure the transition is as smooth as possible. The new Medicare beneficiary identifier (MBI) will …
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Going to the emergency room for a simple sore throat will cost Georgians who get their insurance through Blue Cross Blue Shield of Georgia as of July 1, when a new rule designed to cut unnecessary healthcare costs goes into effect. In a nutshell, it demands that patients choose another care setting unless they have a true emergency—urgent care being the most likely source, given the difficulty many find when trying to make timely appointments …
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Aetna has apparently had enough of trying in vain to make participation in Affordable Care Act (ACA, or “Obamacare) exchanges profitable, and will exit all ACA exchanges for the 2018 coverage year. They follow a long line of insurers who already checked out, complaining that the ACA program simply made it impossible to conduct business, economically. Aetna announced their plans right after revealing that they’d drastically reduce their exchange business for the 2017 coverage year, …
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Missourians who still haven’t gotten the message that the emergency room is the wrong place to be for a sore throat or other nonemergent complaints are in for a rude awakening if they’re covered by Anthem. Starting this summer, Anthem will stop paying a dime for visits to Missouri EDs if the patient is deemed to have a “minor ailment” (which, in addition to sore throat, includes, rash, mild fever, and ear or eye pain—anything …
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Illinois is not unique in wrestling with Medicaid managed care plan problems, but the situation there seems to have reached a boiling point and can serve as a cautionary tale for urgent care stakeholders across the country. Health system officials there complain that getting providers approved by Medicaid managed care plans has taken anywhere from 6 months up to a whole year. Prior authorizations and reimbursements have been similarly slow in coming, making it so …
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Blue Cross Blue Shield (BCBS) of Michigan and Blue Care Network have apparently seen the light when it comes to the benefits of telemedicine. They’re working with physician groups on creating new financial incentives to expand member utilization. Seventeen groups, in fact, have already submitted telemedicine plans that could reap additional payments. Others are strategizing the best way to incorporate or expand telehealth offerings. BCBS says urgent care will figure prominently in its own efforts. …
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The Centers for Medicare & Medicaid Services is going to issue new Medicare cards, replacing beneficiaries’ Social Security numbers with unique ID numbers, by April 2019. However, the Health & Human Services Advisory Panel on Outreach and Educations says CMS isn’t doing enough to share more about the process with healthcare providers, who will have to make significant changes in their billing practices as the new ID card system is implemented gradually; CMS will start …
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Aetna Inc. and Humana Inc. have opted not to fight the decision a judge laid down to block their proposed merger based on the presumption that the $34 billion deal would violate antitrust laws. The two companies will continue to operate as separate entities, though the door is still open for either or both to seek other partners. Had the deal gone through, Aetna would have become a kingpin in Medicare Advantage. The implications for …
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While previous attempts have crashed and burned, proposed new legislation could move California one step closer to a single-payer healthcare system. Proponents in the state senate say it is the “intent of the Legislature” to enact such a law “for the benefit of everyone in the state.” However, specific details and a prospective timetable have not been revealed. If it does pass and ultimately get signed into law, the measure would replace private insurance in …
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