Category Archive: FierceHealthPayer

OIG: Acute care hospitals owe Medicare $51.6M, CMS agrees to provider clawbacks

Medicare inappropriately paid millions to acute care hospitals for outpatient services they provided to patients who were inpatients at other facilities, according to a new OIG report. CMS has agreed to claw back those payments and require hospitals to refund patient co-pays and deductibles. 

Graham-Cassidy bill’s pre-existing condition protections an ’empty promise,’ experts say

As has been the case with previous Republican healthcare bills, the national conversation surrounding Sen. Bill Cassidy and Sen. Lindsey Graham’s legislation has become fixated on one issue: pre-existing conditions. With Jimmy Kimmel making one claim and President Donald Trump hitting back, we asked healthcare policy experts to settle the dispute over the law’s protections for sick enrollees.

Hospital Impact—How to pick the right provider partner for a value-based care arrangement

As the healthcare industry continues to move toward value-based delivery and payment models, payers must rethink the way they engage with provider partners. But while this necessary cultural shift will ultimately improve relationships with all in-netwo…

Graham-Cassidy’s ascent puts the brakes on Senate’s push for bipartisan ACA fix

Though the Senate HELP Committee held hours of hearings to discuss a bipartisan fix for the Affordable Care Act exchanges, its attempt to craft such a measure have ground to a halt. Committee Chairman Lamar Alexander, R-Tenn., said Tuesday that he and Ranking Member Patty Murray, D-Wash., “have not found the necessary consensus among Republicans and Democrats to put a bill in the Senate leaders’ hands that could be enacted.”

Anthem to acquire Medicare Advantage insurer HealthSun

Anthem announced Wednesday that it has reached a deal to acquire Florida-based Medicare Advantage insurer HealthSun from a consortium of investors led by Summit Partners. Once the transaction closes, Anthem’s affiliated Medicare and Medicaid plans will grow to serve more than 650,000 members in Florida.

Premiums for employer-sponsored insurance increase slightly for sixth straight year

Premiums for employer-sponsored insurance have edged up for the sixth straight year, according to a new report. Premiums increased by an average of 3%, to an average of $18,764 this year, according to a report from the Kaiser Family Foundation, Health Research and Education Trust and Health Affairs.

In wake of Trump navigator cuts, Oscar Health gets a head start on open enrollment with new ad campaign

Health insurance startup Oscar Health will get an early jump on advertising for the 2018 open enrollment period, as the federal government significantly scales back its own contributions to the effort. The Oscar campaign represents a departure from the cartoon-style look and feel of its previous collateral. 

CBO report on Graham-Cassidy won’t include premium, coverage data; Ryan says he’ll skip conference committee

The Congressional Budget Office has warned that it won’t release a full score on the Graham-Cassidy bill before a Senate vote. House Speaker Paul Ryan, R-Wis., said Monday night that the bill is “our best, last chance to get repeal and replace done” and said he’d bring it to the House floor without going to conference committee if it passes the Senate.  

HELP committee’s attempts at a bipartisan ACA fix at odds with Republicans’ last-ditch repeal efforts

A Senate committee that wants to write bipartisan legislation to stabilize the ACA’s individual marketplaces, add some certainty for insurers who offer those plans and keep premium costs down for millions of Americans is getting flak from both the left…

How providers, payers can change the conversation about pain management

One way to solve the opioid crisis and improve chronic pain management is to change the conversation about pain and addiction. And that means the healthcare industry must separate those two subjects and create a new dialogue about pain management, said…

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