Maryland Insurance Costs Rise Despite Hospital Price Controls
July 24—Despite a unique price control system for Maryland hospitals, insurers in the state’s Affordable Care Act (ACA) individual health insurance market have requested the largest average rate increase in the country.
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.
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.
July 23-27: Providers Examining Why APMs Are Expected to Stall
July 19—Provider organizations next week will continue their analysis of the recently issued massive Medicare physician payment proposed rule, including the surprise projection that alternative payment model (APM) participation may decline.
3 Strategies for Taking Control of Payer Management
Three strategies can help hospitals and health systems prioritize payer contract management.
March Toward Value-Based Care Slipping: Survey
July 18—A new survey of physicians and health plan execs says the march toward value-based care is slipping, throwing shade on other surveys that say the transition to outcomes-based payment is on track.
CY2019 Home Health Prospective Payment System Proposed Rule: HFMA Executive Summary
This document summarizes the proposed rule updating payment rates under the home health PPS for CY2019, published by CMS.
Payer access to EHR data improves cash flow
Sharp Healthcare gives some payers limited access to their members’ EHR data, which reduces the time-consuming cycle of level-of-care authorization denials, appeals, and ultimate approvals.
Medicare Physician Pay Rule Targets Reporting Burden
July 17—Physician advocates are hailing a range of Medicare policy changes that were included in a recently proposed payment rule and are aimed at reducing clinicians’ administrative burden.
CMS Tweaks BPCI-A Time Frames
July 16—Some key timing parameters of the next large Medicare alternative payment model were changed in recent weeks.