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.
Taking on Risk? Top Ways to Leverage Strategic Partnerships for Integrated Care
Jim Wieland discusses the steps a practice took, and the lessons it learned, as it formed the nation’s first cardiology accountable care organization.
Amid Headwinds, For-Profit Hospital Outlook Stays Stable
Oct. 24—The outlook among for-profit hospitals remains stable over the coming 18 months, according to Moody’s Investors Service.
Medicaid Managed Care Overhaul Could Follow Election
Oct. 23—A so-called mega rule to overhaul federal standards for Medicaid health plans could come days after the midterm election, an industry leader said this week.
Understanding the 7 Options for CMS’s Hospital Charge Posting Rule
Hospitals can choose to post charges in a variety of ways, but not all methods comply with CMS’s recent rule that takes effect on Jan. 1, 2019.
Comprehensive Compliance-Focused Processes for Physician Arrangements
Karin Chernoff Kaplan reviews the basics—and the importance—of establishing consistent processes for setting up and managing physician compensation agreements and thresholds that avoid regulatory problems.
What Changes Are Coming to Medicaid in 2019?
Oct. 16—Additional state expansions of Medicaid eligibility are among the expected developments coming next year to the program, according to a former federal leader of Medicaid.
The Controversy over the Rules of the Game for the Medicare Shared Savings Program
Ken Perez examines the fundamental disagreement over how MSSP ACO savings are being measured and the potential fallout as participants consider leaving the program.
More than 1,500 Provider Organizations Join New Bundle
Oct. 9—The latest Medicare bundled payment model gained 50 percent more provider organizations than its predecessor.
Transitioning to a New Medicare Benchmarking Paradigm
As commercial health plans adopt a case-rate approach to payment based on Medicare’s MS-DRGs, modifications are needed to account for how health plans’ populations differ from the Medicare population.