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Becker's Hospital Review
U.S. Supreme Court justices heard arguments Jan. 15 in a case to determine whether HHS inappropriately altered methods for calculating Medicare hospital reimbursement, The Epoch Times reported.
At issue in Azar v. Allina Health Services is the federal government's decision to include Medicare Part C enrollees with Medicare Part A enrollees when calculating disproportionate share hospital payments.
The changes, which resulted in lower payments to various hospitals, were made in 2013, and Minneapolis-based Allina subsequently sued the federal government in 2014.
Belleville News-Democrat
Montana lawmakers and the state insurance commissioner are targeting a generally hidden part of the health care system, with new regulations aimed at bringing down prescription drug costs. Companies in the drug supply chain, and the state's biggest health insurance company, are fighting back.
In recent years, both Gov. Steve Bullock's administration and State Insurance Commissioner Matt Rosendale have tried to change how companies called pharmacy benefit managers, or PBMs, operate in the state.
Insurance Business Magazine
Addressing conditional payments in workers' compensation cases adds an additional layer of complexity to the underlying claim.
"We are seeing Medicare be more accepting of the disputes of the underlying claim when Medicare is seeking collection directly against the carrier based upon Ongoing Responsibility of Medical (ORM) reporting. However, when Medicare is seeking collection based upon settlement, Medicare is less flexible in accepting the disputes of the underlying claim, unless you can show the treatment is unrelated to the settlement or claim," says Patrick Czuprynski, director of Lien Resolution, NuQuest.
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Pew Charitable Trusts
In 2019, many states are likely to continue efforts to expand access to dental care to more of their residents through multiple approaches, including extending dental coverage to those newly eligible for Medicaid and making greater use of dental therapists.
Nationwide, oral disease rates are down and the proportion of Americans with dental insurance is up, but inequities persist in both health status and access to care. More than 73 million people, disproportionately low income, lack dental insurance, while nearly 57 million live in areas with dentist shortages.
Insurance Journal
The North Carolina Industrial Commission's Compliance and Fraud Investigative Division collected more than $3.2 million in penalties and issued 289 criminal charges at the end of the first two quarters of Fiscal Year 2018-19 as it continues to identify businesses out of compliance with the Workers' Compensation Act, according to a statement from the commission.
The division's Compliance Unit handles civil cases and issues civil penalties to non-insured businesses for failure to carry the requisite workers' compensation insurance.
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Healthcare Informatics
The healthcare industry continues to make progress automating business processes, but significant gaps remain, representing an opportunity for $12.4 billion in savings through further automation, according to new data from the 2018 CAQH Index.
Electronic adoption and transaction volume increased in 2018, with several common transactions reaching 80 percent electronic adoption across the sector, according to the latest CAQH Index. This progress resulted in a narrowing of the cost savings opportunity for the first time in CAQH Index history.
MedPage Today
While uninsured rates fell in states that opted for 2014 Medicaid expansion under the Affordable Care Act, quality of hospital care didn't rise for low-income individuals with acute MI, a registry study found.
From 2012 to 2016, uninsured status declined faster among those hospitalized for an acute MI when the hospital was located in these expansion states. At the same time, Medicaid coverage increased more dramatically in expansion states (from 7.5 percent to 14.4 percent) than in non-expansion states.
Healthcare Finance
The mid-revenue cycle management and clinical documentation improvement market is expected to reach $4.5 billion by 2023, up from $3.1 billion in 2018, at a compound annual growth rate of 7.9 percent.
That's the verdict of a new ResearchAndMarkets.com analysis. It found that market growth is largely being driven by the increasing utilization of mid-RCM solutions to reduce healthcare costs, check the loss of revenue due to medical billing and coding errors, resolve issues raised by the decline in reimbursement rates, manage ever-increasing amounts of unstructured data, and maintain regulatory compliance.
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NAHU Newswire
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NAHU Newswire is a daily brief featuring the latest news of interest to healthcare agents and brokers, selected from thousands of sources by the editors of MultiView. NAHU personnel, in accordance with internal policies, do not approve all stories selected. Any comments regarding content of this publication should be emailed to NAHU. It should not be understood or inferred from the presence of advertisements that NAHU endorses any products or services advertised. Similarly, NAHU is not responsible for the quality of journalism reflected in the articles: it should not be understood or inferred that NAHU supports the information provided. MultiView and NAHU are not liable, for any delays or inaccuracies in the information contained in this brief, nor for any actions taken or outcomes resulting from relying on the information provided herein. |
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