Health Plan Payment and Reimbursement

Aug. 6-10: As Navigator Deadline Approaches, Individual-Insurance Market Strengthens

Aug. 2—As the Trump administration prepares to accept the latest round of navigator applications this week, the individual health insurance market appears to be strengthening. 

Rich Daly August 3, 2018

Why Two Health Systems Opted Not to Launch Their Own MA Plans

July 23—After hospitals and health systems have had some highly publicized struggles operating their own Medicare Advantage (MA) plans in recent years, two health systems recently opted to partner on an MA plan with an insurer.

Rich Daly July 24, 2018

States Trying to Stabilize ACA Marketplaces

July 19—Amid growing policy uncertainty at the federal level, states are undertaking a range of responses to stabilize the individual-insurance marketplaces. But so far, the effect is uncertain.

Rich Daly July 20, 2018

Exemptions to Anthem’s ED Policy

Anthem will not deny an ED claim based on the prudent layperson standard if certain conditions apply.

HFMA July 12, 2018

MA Gets Better Outcomes Despite Sicker Enrollees: Study

July 10—Contrary to general belief, Medicare Advantage (MA) plan enrollees are initially sicker than those in fee-for-service (FFS) Medicare, according to new research. And once enrolled, MA beneficiaries get better care at a lower cost.

Rich Daly July 11, 2018

Pilot to Offer APM Bonuses to Physicians in Medicare Advantage

July 3—Medicare plans to launch a pilot—as soon as this year—to allow physicians paid through Medicare Advantage value-based arrangements to qualify for the same bonuses as those working in advanced alternative payment models.

Rich Daly July 3, 2018

Definition of “Employer” under Section 3(5) of ERISA – Association Health Plans Final Rule Executive Summary

This document summarizes the Employee Benefits Security Administration's Association Health Plans final rule, published in the June 21, 2018, Federal Register.

HFMA July 3, 2018

Rejecting Hospital Concerns, Administration Expands Association Plans

June 19—Despite calls from major hospital groups to drop a proposed expansion of association health plans (AHPs), the Trump administration has finalized those rules.

Rich Daly June 20, 2018

June 4-8: High-Deductible Health Plans Draw Congressional Scrutiny

May 31—Amid record-breaking enrollment in high-deductible health plans (HDHPs), a congressional panel plans to examine their growth and consider policies to bolster health savings accounts.

Rich Daly May 31, 2018

How MA Plans Are Changing VBID Approaches

May 18—Medicare Advantage (MA) plans are evolving their approaches in the expanding Medicare pilot for value-based insurance design (VBID).

Rich Daly May 21, 2018
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