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Don't Give Up on Dead Claims
Fri, 02/03/2012 - 07:27Denials can wreck a provider’s revenue stream, but physician practices often give up on payment too soon, says an attorney. "Providers have a lot more leverage than they realize," he says.
Categories: Healthcare News
House repeals long-term care program Obama viewed as too costly
Fri, 02/03/2012 - 06:55The U.S. House repealed a long-term care insurance program created by the 2010 health-care law that the Obama administration decided was too costly to put in place. The 267-159 vote sends the bill to the Senate, where Democrats don't plan to bring it up. The program, known as the Class Act, was proposed by the late Senator Edward Kennedy, the Massachusetts Democrat who died in August 2009 before passage of the law. "While the goals of the program are worthy, good intentions don't make up for fundamentally flawed, actuarially unsound policies designed to show the illusion of savings," Pennsylvania Republican Joe Pitts, chairman of the House Energy and Commerce health subcommittee, said during yesterday's floor debate.
Categories: Healthcare News
Insurer Cigna's 4th quarter profit drops 37 pct
Fri, 02/03/2012 - 06:30Cigna's fourth-quarter earnings dropped 37 percent compared to the same period last year, when the managed care provider recorded a $101 million gain related to the completion of an IRS audit. Results fell well short of Wall Street expectations, and Cigna shares tumbled in Thursday premarket trading. The Bloomfield, Conn., health insurer also recorded a $28-million charge in the 2011 quarter related to its acquisition of insurer HealthSpring Inc., a $3.8-billion deal it completed on Tuesday. Cigna earned $290 million, or $1.04 per share, in the three months that ended Dec. 31. That compares to $461 million, or $1.69 per share, in the 2010 quarter. Revenue climbed less than 1 percent to $5.46 billion.
Categories: Healthcare News
Businesses divided on VT healthcare exchange legislation
Fri, 02/03/2012 - 06:15The business community sent a mixed message to lawmakers Wednesday about the future of health care for their employees. Some business owners are concerned that they will have to give up the health insurance plans they have worked hard to set up as the state transforms its health care system. Others feel their costs of paying for health care are breaking the bank, and they want everyone to pay into a program that provides care for everyone.
Categories: Healthcare News
Healthcare reform saves MI Medicare recipients $49M on prescriptions
Fri, 02/03/2012 - 06:05More than 84,000 Michigan residents receiving Medicare benefits saved nearly $49 million on prescriptions in 2011 under health care reform, the U.S. Department of Health & Human Services said Thursday. Health care reform provided seniors with Medicare a 7 percent discount on covered generic medications when they hit the prescription drug coverage gap called the donut hole. This year, health care reform provides Medicare recipients a 50 percent discount on brand-name prescriptions and a 14 percent discount on generics. "The Affordable Care Act is already saving money for millions of Americans with Medicare," Kathleen Sebelius, U.S. Health & Human Services Secretary, in a statement.
Categories: Healthcare News
Sebelius: Healthcare law makes Medicare stronger, more affordable
Fri, 02/03/2012 - 06:00When President Barack Obama delivered the State of the Union last week, he talked about American values—the idea that if you work hard and play by the rules, you should be able to make a good life for yourself and family, and have something left for retirement. Part of those values is the promise of Medicare that older Americans won't have to spend the last part of their lives worrying about going broke from a hospital bill. Today, I am visiting Tampa to talk about how the 2010 health care law, the Affordable Care Act, is strengthening that promise.
Categories: Healthcare News
Medicare Advantage Enrollment Grows, Premiums Shrink
Thu, 02/02/2012 - 07:52Medicare Advantage plans are showing a 10% increase in enrollment from a year ago, says U.S. Health and Human Services Secretary Kathleen Sebelius, but the insurance industry warns of dramatic declines in the future.
Categories: Healthcare News
War savings may be key to long-term 'doc fix' deal
Thu, 02/02/2012 - 07:15KHN's Mary Agnes Carey talks with Jackie Judd about the congressional conference committee trying to hammer out a bargain on a payroll tax cut extension and the Medicare "doc fix." If the conferees—who are now discussing the possibility of a permanent "doc fix"—fail to agree to a proposal, doctors who see Medicare patients are in line for a 27 percent cut slated to take effect in March.
Categories: Healthcare News
Healthcare Reform an Insider's Game Now
Wed, 02/01/2012 - 10:59In this election year, the complexity of delivering quality care at a lower cost has been reduced to tightly controlled messaging by the President and his opponents. Insiders, however, have their eyes firmly set on Big Ideas.
Categories: Healthcare News
Opinion: The end of health insurance companies
Wed, 02/01/2012 - 07:11Here's a bold prediction for the new year. By 2020, the American health insurance industry will be extinct. Insurance companies will be replaced by accountable care organizations—groups of doctors, hospitals and other health care providers who come together to provide the full range of medical care for patients.
Categories: Healthcare News
CMS finds critical missteps at NC hospital
Wed, 02/01/2012 - 06:53Documents from the Centers for Medicare & Medicaid Services reveal it took Gaston Memorial Hospital staff some six hours to realize a nurse gave an emergency-room patient insulin instead of potassium. A spokeswoman with CaroMont Health, which operates the hospital, said the company may appeal some of the findings in the government's report as misleading, inaccurate, or based on insufficient facts.
Categories: Healthcare News
Opinion: The secret of American healthcare
Wed, 02/01/2012 - 06:46 Almost nothing that politicians are currently debating is likely to change the overall costs of care. What's merely at stake is the shell game about who appears to be paying. Hiding the redistribution inherent in American health care has a corrosive effect on our national dialogue.Categories: Healthcare News
Strategies for Effective Transitions of Care
Tue, 01/31/2012 - 09:34Technology, including electronic medical records and health information exchanges, is evolving to support actively managed care transitions. Arien Malec, Vice President of Relay Health Data Platform Solutions, discusses strategies for effective transitions of care to improve patient outcomes and reduce errors and costs across the care continuum. [Sponsored by RelayHealth]
Categories: Healthcare News
Blue Cross moves to dismiss Aetna antitrust suit
Tue, 01/31/2012 - 07:03 Blue Cross Blue Shield of Michigan on Monday said it has asked a Detroit federal judge to dismiss an antitrust lawsuit by insurance giant Aetna Inc. Hartford, Conn.-based Aetna filed the lawsuit last month against the Blues, claiming the state's largest health insurer has prevented Aetna from expanding in Michigan. The lawsuit is a piggyback on the fall 2010 lawsuit by the U.S. Department of Justice and former Michigan Attorney General Mike Cox that accuses the Blues of stifling competition and driving up rates for consumers through the use of certain requirements in hospital contracts that are called most-favored nation clauses.Categories: Healthcare News
Labor ills, budget gap slam Westchester Medical Center
Tue, 01/31/2012 - 06:55With strained labor relations in the wake of 400 job cuts and leaders still grappling with a $26 million budget gap, there seems to be no panacea for the woes at Westchester Medical Center. The medical center is dealing with the same financial problems as other hospitals—declining Medicaid and Medicare reimbursements—but because it's a public-benefit corporation, it has the added pressure of state pension payments, said Kevin Dahill, president of Northern Metropolitan Hospital Association, which represents hospitals in the Hudson Valley.
Categories: Healthcare News
Medicare clinics see surprising shortage of Anchorage patients
Tue, 01/31/2012 - 06:47Medicare patients flooded two new clinics targeting the older population when they opened in Anchorage last year—most other primary care doctors wouldn't take the federal insurance for seniors because they say Medicare pays too little. Recently, the demand to get into the clinics has eased, and clinic officials are beginning to wonder: What happened to the rest of the Medicare patients? Are they finding doctors Outside where they go in winter? Are they seeing specialists like cardiologists and pulmonologists for all of their needs? Are they just not sick?
Categories: Healthcare News
Portland ME mayor decries proposed DHHS cuts
Tue, 01/31/2012 - 06:44 Gov. Paul LePage's attempt to balance the state's books by overhauling MaineCare unfairly passes the buck to local governments, hospitals and social service agencies, Portland Mayor Michael Brennan said Monday. LePage's plan eliminates $2 million from city programs and includes $20 million in cuts to Portland hospitals, Brennan said at his first news conference since taking office in December.Categories: Healthcare News
TX Strikes Out on MLR Waiver Request
Mon, 01/30/2012 - 07:28The Centers for Medicare & Medicaid Services has rejected what has become a standard argument among waiver applicants, that the 80% medical loss ratio requirement would destabilize the state's individual market and cause insurers to withdraw.
Categories: Healthcare News
Another View: Early signs show business is accepting Affordable Care Act
Mon, 01/30/2012 - 07:07The legal bees may be busy at the U.S. Supreme Court preparing for March's oral arguments over the legality of the Patient Protection and Affordable Care Act, but there's no question that health-care reform so far has been good for the major players of the health-care industry. Notwithstanding a fourth quarter that was less profitable than expected, health insurer WellPoint Inc. said Tuesday that it netted about $2.6 billion in 2011, the first full year since the Affordable Care Act became law. A week earlier, UnitedHealth Group Inc., the nation's largest health insurance provider, said it took in more than $100 billion in 2011 and had more than $5.1 billion left in net income.
Categories: Healthcare News
Federal government rejects TX insurance waiver
Mon, 01/30/2012 - 07:01 The federal government on Friday rejected a request by Texas to be excluded from a new law that limits how much health insurance companies can spend on overhead. The law is part of the Affordability Care Act, changes made in federal health care law in 2010 that Texas officials say is unconstitutional. Part of the bill, known as the medical loss ratio requirement, says that health insurers must spend at least 80 percent of their revenue on providing health care or health improvement programs. Health insurers who spend more than 20 percent on overhead and executive salaries will be required to give rebates to customers starting this year.Categories: Healthcare News
M2PowerInc
Making Sense of Meaningful Use
- Mostashari Says Health Information Exchange Will Ramp Up This Year
- Millions with Medicare enjoyed lower costs and better benefits in 2011
- MGMA Executive Urges HHS To Address HIPAA 5010 Challenges
- Survey: 51% of Midsize Physician Practices Have Fully Implemented EHRs
- CMS Posts Central-Line Infection Data to its Hospital Compare Site
American Medical News - Gov't
Healthcare News
HealthLeadersMedia.com - Managed Care Contracting and Reimbursement Advisor
OIG News
OIG Criminal & Civil Enforcement
- Two Miami-Area Residents Plead Guilty in $25 Million Health Care Fraud Scheme
- Boston Scientific Subsidiary Guidant Pays U.S. $9.25 Million to Settle False Claims Act Allegations
- Manhattan U.S. Attorney Announces Settlement With Podiatrist To Pay $800,000 For Submitting False Medicare Claims
- Ten Miami-Area Residents Plead Guilty in $25 Million Health Care Fraud Scheme
- Owner of Miami-Area Mental Health Company Sentenced to 35 Years in Prison for Orchestrating $205 Million Medicare Fraud Scheme
