UnitedHealth Facing Financial Issues In ACA Healthcare

UnitedHealth’s earnings report reveals it has been losing significant money on the HIEs established under the Affordable Care Act. Consequently, the insurance provider is considering withdrawing from the Exchanges by 2017. On the subject of how much money they lost, UnitedHealth revealed in a regular earnings conference call with stakeholders and analysts that the estimate…

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MedPAC Suggests Modifications In MA Plans

One of the main topics discussed during the December meeting of Medical Payment Advisory Commission (MedPAC) was about a proposal that would rule out certain sections of the existing formula used for calculating the payments for Medicare Advantage (MA) plans. They thought that the current formula was incapable of compensating the plans fairly. The proposal…

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District Court Of Appeals Judges In Favor Of Healthcare Provider

December 2015 saw the judgment on a crucial case in the healthcare industry. The case was between a prominent insurance service and a healthcare provider, about the assignment of an out-of-network health insurance payment to the healthcare practitioner. The Third Circuit Court of Appeals, under whose jurisdiction both the insurance service and healthcare provider come,…

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Risk Corridor May Be A Problem For Both Insurers And HHS

The ACA is has a requirement for insurance companies and Co-Ops to take part in HIEs, as a way to return part of their profits to the Federal government when their profit amount is thought to be excessive. The excess money is put into a Federal pool and made available towards the reimbursement of those…

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CMS Proposes Criteria For 2017 Exchange Plan

The Centers for Medicare and Medicaid Services issued its annual proposed rule on 20 November 2015. Therein, the agency summarizes the criteria for health insurance plans which will be sold in the 2017 plan year. On top of the several highly technical insurance disputes, the proposed rule is meant to set up a new policy,…

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ACA Open Enrollment Proceeding Full Ahead

The ACA open enrollment is proceeding. Health insurance claimants for plans sold on the federal and state HIEs are enrolling at present, and there is very little time left for individuals who have yet to select a plan for 2016. Following a solid initial two weeks compared to what has been seen in previous years,…

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CMS Releases Draft Letter On Exchange Sold Health Plans

The Centers for Medicare and Medicaid Services (CMS) insists that Exchange Sold Health Plans should be based on a set of requirements. As such, it has released a list of requirements that these plans should be based on for the year 2017. The draft letter of the requirements is given out to the issuers in…

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CMS Seeks Public Opinion On Improving MAC Contracts

In a latest move, the Centers for Medicare and Medicaid Services (CMS) have decided to seek opinions from public on improving Medicare Administrative Contractor (MAC) contracts. As part of the process, it issued an official Request For Information (RFI) in the Federal Register. The decision is said to help CMS in monitoring the MAC contracts.…

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Issues Arise In Processing ICD-10 Claims

The move to ICD-10 has apparently evaded most of the obstacles healthcare stakeholders predicted. Despite that, HBMA members have uncovered many challenges in the transition to the new coding system. Members of the association have encountered issues at the Medicare Administrative Contractor level, with claims having to do with National Coverage Determinations, and Local Coverage…

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US Congress Passes Fiscal Year 2016 Omnibus Appropriations Bill

The US Senate passed a crucial bill on 18 December 2015, on the last legislative day of year. The bill titled ‘Fiscal Year 2016 Omnibus Appropriations’ is designed to fund the federal government activities thorough the fiscal year 2016. The bill was passed at the House the previous day. President Obama signed the bill into…

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