On September 22, 2016 the NCQA announced the release of the 2016-2017 Health Insurance Plan Ratings, this is the second year of the NCQA's new rating methodology. The Health Insurance Plan Ratings. which are published annually and compare the quality and services of more than 1,000 health plans across the United States. One new aspect of the 2016-2017 ratings is that WebMD will be publishing the ratings on their WebMD.com.
According to a recent Revive Health Inforgraphic, the percentage of healthcare leaders who have trust in any payer is eroding over time. Revive Health conducted a survey where they targeted 201 hospital leaders who "negotiate and/or approve managed care contracts with national health insurance companies. "
The CMS announced the redesign of the Medicare Advantage Value-Based Insurance Design (MA-VBID) model. The two phase process will start in January of 2017 and continue for 5 years. Previous Medicare Advantage requirements have not incorporated...
The healthcare industry is constantly changing. From legislation to trends in care, it's often daunting to stay on top of the changes. Payers can rely on professional development and continuous training for staff to help keep them up to date with changes in their industry.
The healthcare industry has undergone major changes since the rollout of the Affordable Care Act and now a new type of reimbursement model is putting traditional incentive based payment models on the shelf for good. Value based reimbursement, which ensures that providers are rewarded for performance, quality, and cost reduction (instead of number of services provided), is a model that will help shape the future of healthcare.
Moving into a realm usually reserved for health care regulators, the California health marketplace Thursday unveiled sweeping reforms to its contracts with insurers, seeking to improve the quality of care, curb its cost and increase transparency for consumers. The attempt to impose quality and cost standards on health plans and doctors and hospitals appears to be the first by any Obamacare exchange in the nation. Among the biggest changes: Health plans will be required to dock hospitals at least 6 percent of their payments if they do not meet certain quality standards, or give them bonuses of an equal amount if they exceed the standards.
Let's talk healthcare trends set into motion by the ACA. The Affordable Act was signed into law March 23, 2010 making 2015 the law’s 5 year anniversary. Can you believe it? Five years later the ACA has sparked change in the healthcare ecosystem and is continuing to churn the wheel of change. But what changes should healthcare organizations expect for the future? PwC Health published a report on post-ACA trends in honor of the law’s 5th anniversary. The report outlines 5 major healthcare trends, Risk Shift, Primary Care, New Entrants, Health Insurance, and States, that it believes the ACA set into motion. We will cover 4 of those trends today!
Denied claims cost healthcare organizations a lot of money each year. Often times, the denials could have been easily avoided. Let's look at the anatomy of a denied claim.
Open enrollment for health insurance under the ACA may have ended February 15, but an extra enrollment period (Special Enrollment Period) will take effect March 15 to April 15. So if you missed the deadline, you might have a few options to get coverage.
Managed care has been around for almost one hundred years, at least in theory. When placed up against fee-for-service payment models, however, it was a hard sell. Traditionally, the way that physicians were compensated for their services was a fairly straight-forward invoicing process: they would bill the patient (or later, the payer) for everything they did in terms of diagnosing or treating the patient. Everything.