Health Insurance Archives - Page 10 of 22 - BHM Healthcare Solutions

Top 8 ACA Delays |Blatantly Illegal or Temporary Courses of Action?

2017-04-02T13:28:34-04:00By BHM Marketing|Compliance, Health Care Reform, Health Insurance, Health Insurance Exchange, Services|

With so many ACA delays thus far, is the ACA really what we bargained for? Should the President have the authority to delay ACA provisions at his discretion or is it his duty to uphold the law as written? The Affordable Care Act was enacted in 2010 with provisions becoming effective over several years, many of which have been delayed. Why the ACA delays? •Limited resources for implementing the law •The need to prioritize limited resources •Technological limitations, such as the “glitches” in the computer systems as they related to the healthcare exchanges •Complaints from various quite vocal groups, both political and non •Undue hardships placed on employers and / or employees •Additional time and / or funding required to comply •Tax and reporting requirements •Political reasons

Millennials: Obamacare Costs Less Than Your Cell Phone Bill

2017-04-02T13:28:34-04:00By BHM Marketing|Health Care Reform, Health Insurance, Health Insurance Exchange|

Americans were a little wary of the healthcare marketplace when it debuted this past year, but now, some are beginning to see the benefits - of the benefits. New data released this week from the Department of Health and Human Services reports that new Obamacare customers are paying, on average, about $82 in monthly premiums for their coverage. For many, that’s less than many of their utility bills, such as internet, cable and smartphones.

Play or Pay | The Triple Aim for 2015 and Beyond

2017-04-02T13:28:37-04:00By BHM Marketing|Health Care Reform, Health Insurance, Health Insurance Exchange|

What will you decide for your organization beginning 2015? Will you “play or pay”? The “play or “pay” principle basically says that if employers with 50 or more full time employees don’t meet the minimum requirements of offering insurance coverage, they will pay very steep penalties. The provision will be phased in beginning in 2015. The “play or pay” principle is part of the PPACA, specifically under the provision of “shared responsibility”.

10 Reasons Your Claim Was Denied

2017-04-02T13:28:37-04:00By BHM Marketing|Financial, Health Insurance, Services|

There are many reasons a claim might be denied, but did you know that many of them are actually simple oversights that can easily be corrected? Check your denials against this list to see how many preventable errors might be costing your hospital money.

Are You Ready for 2015 Readmission Penalties?

2017-04-02T13:28:37-04:00By BHM Marketing|Clinical Analysis, Health Care Reform, Health Insurance, Medicare and Medicaid, Readmissions, Services|

What are you doing to make sure you are not one of the 66% of hospitals who will be assessed readmission penalties in the next round? Can you afford the penalties which are increasing again in 2015? Are you aware of the proposed conditions to be added in 2015? What do you get when you combine Medicare, high readmissions, within a 30 day window, for specific conditions? A reduction in Medicare spending to the tune of about $280 million annually. Of interest is that penalties were assessed in 49 states, all with the exception of Maryland, who has a unique reimbursement payment system.

9 Criticisms to the Readmission Reduction Program

2017-04-02T13:28:37-04:00By BHM Marketing|Clinical Analysis, Compliance, Financial Analysis, Health Care Reform, Health Insurance, Medicare and Medicaid, Quality Improvement Programs, Readmissions, Services|

The Readmission Reduction Program is designed to reduce healthcare spending while improving quality. There are both proponents and opponents of the program. Let’s delve into the improvements that could be made to the current system. So, as most of you are aware, CMS under the direction of HHS created the Hospital Readmission Reduction Program in order to reduce healthcare spending while improving the quality of care. The program is being phased in beginning with a 3 year baseline period in which hospitals were required to report all readmissions (within 30 days). CMS assessed and analyzed all of the available readmission data to determine how penalties should be assessed, for which conditions, and excluding certain circumstances. Beginning in October 2012, penalties were assessed to over 2,200 hospitals, equating to about $280 million. The phase in included an increase in penalties from 2013 to 2015 from 1% to 3%, where it is currently capped. Initially, there were 3 conditions included: Acute Myocardial Infarction, Heart Failure, and Pneumonia. For 2015, CMS is proposing 2 additional conditions: Chronic Obstructive Pulmonary Disease and Elective Hip and Knee Replacements.

ACA Acronyms | FFOF | Everything Has an Abbrev.

2017-04-02T13:28:38-04:00By BHM Marketing|Accountable Care Organizations, Health Care Reform, Health Insurance, Health Insurance Exchange, Physician Compensation, Services|

What do the ACA, ACO, FFS, DHS, and QHP all have in common? They are healthcare acronyms and most are related to the Affordable Care Act. The healthcare industry is not unlike any other industry or almost any aspect of our lives these days, especially with the advent of texting. There is always a shorter way to say something i.e. “BFF” – best friends forever or one of my favorites “*$” - Starbucks. By the way, the title “FFOF” is Fun Facts on Friday. The ACA, which is part of the “PPACA” - Patient Protection and Affordable Care Act of 2010, is regulated by “HHS” - the division of Health and Human Services, the “DOL” – Department of Labor and the “IRS” – Internal Revenue Service. HHS designates many responsibilities to “CMS” – the Centers for Medicare and Medicaid Services.

Obamacare & Murphy’s Law | Did It All Go Wrong?

2024-06-27T11:54:49-04:00By BHM Marketing|Health Care Reform, Health Insurance, Health Insurance Exchange|

Pundits began outlining the downfall of Obamacare as soon as the President was elected in 2008. Now that many programs have come to fruition, many folks who originally voiced concerns are tallying up the negative outcomes.

Show Me the Money | Profitability Through Value-Based Purchasing

2023-06-29T12:06:18-04:00By BHM Marketing|Accountable Care Organizations, Care Coordination, Financial Analysis, Health Care Reform, Health Insurance, Physician Compensation, Services|

Summary: Are you ready for a shift in risk from payer to provider? Will you be ready for value-based purchasing when it becomes required? Are you utilizing other reimbursement models such as bundled payments, Accountable Care Organizations, and Population Health Management? From a provider perspective, healthcare reform is aimed at tightening the purse strings, working more efficiently, reducing waste, and improving quality. The shift of risk has begun which will transform healthcare from a fee-for-service to fee-for-value. When the ultimate transformation ends, is still uncertain. As such, fee-for-service is still being utilized and providers are still generating profits and revenue based on the volume mentality while simultaneously trying to transition to a volume and quantity mentality. Juggling the opposite ends of the spectrum is no easy task.

Understanding Utilization Review

2024-06-19T07:51:18-04:00By BHM Marketing|Health Insurance, Physician Advisor/Peer Review, Services|

When a patient needs medical treatment of any kind, their insurance company needs a way to establish how much they’re going to pay for the services. An insurance company may review a treatment or procedure to determine if it is appropriate, and therefore, if they’ll cover the cost. If an insurance company denies coverage, a patient or healthcare provider can appeal the decision.

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