In an interesting turn for political support, there now exists a desire by a small number of Georgia Republicans that are now open to the idea of expanding Medicaid. However, they will face significant hurdles to do so. The conservative…
There continues to be developments regarding the proposed mergers between Anthem/Cigna and Aetna/Humana. Yesterday, the Justice Department reported will likely file lawsuits this month to halt both proposed mergers. If the Justice Department does take action, it may significantly delay…
The Merit-Based Incentive Payment System (MIPS) is the future value-based program for Medicare Part B Providers that should be considered the default Medicare payment program beginning January 1, 2019 with a two-year look-back, therefore truly beginning in 2017. This program…
As the healthcare industry continues to evolve, the Center for Medicare and Medicaid Services (CMS) has proposed five changes for the Patient Protection and Affordable Care Act. The proposed changes are focused on: Risk Adjustment, Network Adequacy, Out-of-Pocket Maximums, Standardized…
The Center for Medicare and Medicaid Services (CMS) released the first set of “Core Quality Measures” this Tuesday, in which CMS and private payers agree to utilize in value-based payments. The collaborative includes members from America’s Health Insurance Plans (AHIP),…
By Lisa Schencker | January 23, 2016 Dr. Mark Monteferrante didn’t think it would be so hard to help his radiology group’s office in Northern Virginia buy a second MRI machine in 2003. But it took five years and more than…
Some consumers who buy coverage on the health insurance marketplaces in 2017 could see their out-of-pocket costs drop significantly under a federal proposal to create standardized plans, a recent analysis found. The government wants to create six plan options at…
TAKE ACTION & GET INVOLVED Contact your legislators! It makes a difference when you contact your Representatives and Senators early in the session. Discuss the issues that are important to your practice, your patients, and your community. The…
The Centers for Medicare and Medicaid Services on Monday proposed new rules to discharge planning requirements for long-term care hospitals, inpatient rehabilitation facilities, critical access hospitals and home health agencies. Under the proposed rule, hospitals and critical access hospitals…
With healthcare reimbursement quickly evolving to primarily a value-based model, many physicians fear the inevitable repercussions of not being prepared for contracting based upon patient outcomes. The unveiling of CMS’ Value-Based Modifier, the general market movement since the Affordable Care Act, the…