Health Plan Payment and Reimbursement

Oct. 28-Nov. 2: As Open Enrollment Looms, Individual-Market Changes Coming

Oct. 25—Next week’s start of open enrollment for the individual health insurance marketplaces comes as the Trump administration moves forward with an overhaul.

Rich Daly October 26, 2018

Sept 30-Oct. 5: ACA Premiums to Decline for First Time

Sept. 27—Final premium rates for the Affordable Care Act (ACA) marketplaces are expected to keep rolling in next week, even as the Trump administration is anticipating a historic first.

Rich Daly September 28, 2018

Aug. 27-31: Individual Market Rates Roll in Amid Tweaks

Aug. 23—States are scrambling to implement last-minute supports for the individual-insurance markets, even as 2019 rates begin to be finalized.

Rich Daly August 24, 2018

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
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