Effect Of Risk Adjustment Of Affordable Care Act On Small Plans

Regional health insurers and many other small co-op plans incurred big charges under the Affordable Care Act’s risk adjustment program. The year 2015 is the second year of risk adjustment and as per the data, many small insurers had to pay for both years. The report also shows the details of payout of the reinsurance…

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AAFP Suggests CMS To Reconsider MACRA

The commenting period set by CMS on the MACRA implementation has ended now. Following that, the American Academy of Family Physicians (AAFP) asked the Centers for Medicare & Medicaid Services to reconsider and slow down with their Medicare Access and CHIP Reauthorization Act (MACRA) implementation. Robert Wergin, chair of the AAFP Board of Directors said,…

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Oncology Care Model Aims To Reduce Cancer Cost – CMS

The Centers for Medicare & Medicaid Services recently announced that 196 practices would be participating in their proposed Oncology Care Model (OCM). CMS says that OCM is designed to decrease the expenditure for oncology without compromising on quality of care. In view of that, Sylvia M. Burwell, Secretary of Health and Human Services said “…the…

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HHS Proposes To Eliminate Backlogs In Medicare Appeals

The Department of Health & Human Services (HHS) plans to clear all backlogs under their new rules. HHS estimates that the Notice of Proposed Rulemaking (NPRM) on proposed changes would reduce the number of appeals going to Administrative Law Judges. Some of the main HHS proposals include; removing some steps in the appeals process, revising…

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ONC Reviews EHR Use And Interoperability

Latest report on EHR adoption and interoperability was released by Office of the National Coordinator for Health Information Technology (ONC). Information that was collected from non-federal acute care hospitals displays increase in both adoption and interoperability. The report says that around 82 percent 0f hospitals shared health information such as lab results with external providers.…

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CMS Eases Restrictions On CO-OP Health Insurers Functions

CMS recently released a final interim rule that eases some restrictions laid on CO-OP health insurers. Experts believe that it is an attempt by CMS to keep CO-OPs from financially sound. The final rule also features a few changes to the special enrollment periods (SEPs) for health exchange sold plans. The Consumer Oriented and Operated…

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Are You Ready For The Upcoming ICD 10 Updates?

The Centers for Medicare and Medicaid Services (CMS) is all set to release 5,500 new codes in October in the wake of smooth ICD 10 transition. Though that sounds too many new rules, these codes are meant to help healthcare providers submit claims more efficiently and improve repayment standards. in relation to that, the American…

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CHIME Highlights The Need Of A Coordinated Cybersecurity Strategy

Expressing concern on the surge in cyber threats in the country, the College of Healthcare Information Management Executives (CHIME) Board Chair, Marc Probst said in a recent interview that the focus of Federal efforts and HHS should be coordination and not organizational reporting designs. Probst, who is also the Vice President and Chief Information Officer…

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Competitive Bidding Report By CMS Receives Mixed Response By CQRC

The Council for Quality Respiratory Care (CQRC) recently said that the data released by CMS in their latest competitive bidding report does not truly reflect on the effect of Medicare cuts enforced on Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) and the home respiratory treatments. Effective Jan. 1, 2016, CMS started to apply the…

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House Committee Hears Testimony From Physicians Regarding MACRA Implementation

The subcommittee of the House Energy and Commerce Committee met on April 19 to hear testimonies from physicians about progress in MACRA implementation. This is the second such hearing, following one, where there was testimony from CMS. MACRA steps into the stead of the long maligned Medicare Sustainable Growth Rate Formula (SGR), as the official…

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