Resources

MSP Recovery Makes History Again

After several wins at the U.S. Court of Appeals for the 11th Circuit, MSP Recovery made history again obtaining class certification for Medicare Advantage Organizations based on the principles of Medicare Secondary Payer law, against IDS Insurance Company. On April 20, 2017, the Honorable Judge Antonio Arzola entered a 56-page Order Granting the Motion to...
Read More

Humana To Focus On Medicare Part D and Medicare Advantage

Humana President and CEO Bruce Broussard said in the company’s annual shareholders’ meeting that the company will focus on Medicare Part D and Medicare Advantage patients. The emphasis on the Medicare population comes as more baby boomers become Medicare beneficiaries. Despite a failed merger with Aetna, Humana had a strong fiscal year. A federal court...
Read More

CMS Wants Private Hospital Error Reports To Go Public

The Centers for Medicare & Medicaid Services (CMS) wants to make reports by private healthcare accreditors public according to a proposed rule. Private accreditors, such as the Joint Commission, may spot errors and safety issues at hospitals during inspections, but the public doesn’t know because the information isn’t released. The proposed rule would require accreditors...
Read More

Supreme Court Rules Against Federal Worker In Health Benefits Case

In Coventry Health Care of Mo., Inc. v. Nevils, the Supreme Court in a unanimous decision found that an express preemption clause in the government’s contracts with private insurers under the Federal Employees Health Benefits Act (FEHBA) trumps state laws that prohibit insurers from demanding the beneficiaries reimburse them. The SCOTUS reversed the Missouri Supreme...
Read More

CMS Issues Proposed Rule for 2018 Payment Policy Updates for Medicare Hospital Admissions

Last week the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update 2018 Medicare payment and policies when patients are admitted into hospitals. The new rule, proposes an increase of about 1.6% in operating payment rates for general acute care hospitals paid under the Inpatient Prospective Payment System (IPPS) that participate...
Read More

Cost-Sharing Subsidies Won’t Ease Insurers’ Uncertainty

The federal government currently pays $7 billion each year to insurers for cost-sharing subsidies and 58% of people who signed up for health insurance through the Affordable Care Act (ACA) this year qualify for these subsidies, according to the New York Times. The HHS will continue to pay cost-sharing subsidies to health insurance companies but,...
Read More

Uninsured Rate Reaches 11.3% At The Start Of 2017

The American uninsured rate increased to 11.3% in the first quarter of 2017 from a record low of 10.9% in the last half of 2016, according to the Gallup-Healthways Well-Being Index. Uninsured rates have been in the minds of many since significant healthcare reform became a distinct possibility late last year. While these numbers could...
Read More

CMS’ Accountable Health Communities Model Selects 31 Participants To Serve As ‘Hub’

The Centers for Medicare and Medicaid has named 32 participants to serve as local “hubs’ linking clinical and community services under its Accountable Health Communities model. Twelve organizations will participate in an Assistance Track, helping high-risk Medicare and Medicaid beneficiaries navigate and access community services. In addition to the navigation service, the 20 organizations in...
Read More

Hospitals Fear Loss Of Medicare Contracts

The Centers for Medicare & Medicaid Services’ (CMS) lack of guidance on a new requirement for hospitals to notify Medicare patients why they are receiving observation care could cause hospitals to lose billing privileges and patients. Under federal law, hospitals must alert Medicare patients when they are getting observation care and they are not admitted...
Read More