Month: December 2021

CMS Updates Affordable Care Act, Public Payer Enrollment Numbers

CMS Updates Affordable Care Act, Public Payer Enrollment Numbers

Affordable Care Act enrollment for 2022 and public payer enrollment midway through 2021 saw some record-breaking surges. In 2020 and 2021, public payer and Affordable Care Act marketplaces experienced major disruptions and changes that continue to have ripple effects. The year that the pandemic struck, Medicaid and CHIP enrollment escalated for the first time in […]
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Medicare Advantage, consolidation drove healthcare insurer trends in 2021

Medicare Advantage, consolidation drove healthcare insurer trends in 2021

  COVID-19 continued to affect the industry, which has plowed forward with expanded offerings, digital transformation and other bold moves. It was difficult to predict trend lines for the payer and health insurance industry in 2021, largely because of persistent uncertainties due to the COVID-19 pandemic. Consumer behavior has become more unpredictable, care models and […]
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Physician Fee Schedule Final Rule for Calendar Year 2022 – CMS Cuts Rates and Extends Telehealth

Physician Fee Schedule Final Rule for Calendar Year 2022 – CMS Cuts Rates and Extends Telehealth

On November 2, 2021, the Centers for Medicare and Medicaid Services (“CMS”) issued its Calendar Year (CY) 2022 Physician Fee Schedule (“PFS”) Final Rule. In this post, we sample some key highlights from the Final Rule. For more detail, take a look at our previous post, in which we highlight the PFS’s changes to the […]
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Telehealth: Key Takeaways from The CY2022 PFS Final Rule

Telehealth: Key Takeaways from The CY2022 PFS Final Rule

In November 2021, the Centers for Medicare and Medicaid Services (“CMS”) issued the Physician Fee Schedule Final Rule (“Final Rule”) which includes several telehealth policy updates that will go into effect in calendar year 2022.1  As a result of the COVID-19 public health emergency (“PHE”),  CMS expanded the availability of telehealth through the use of […]
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How Population Health, Risk Stratification Support Value-Based Care

How Population Health, Risk Stratification Support Value-Based Care

To excel in value-based care, providers must lean on strategies for managing population health and skillful risk stratification. Amid the COVID-19 pandemic, organizations observed the ramifications of fee-for-service, leading to communication and revenue challenges for both providers and patients. While value-based care is not a novel idea, the pandemic greatly accelerated the adoption of this […]
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6 BEST REIMBURSEMENT STORIES OF 2021

6 BEST REIMBURSEMENT STORIES OF 2021

  Here are the six best reimbursement stories from 2021 HealthLeaders’ coverage and beyond. COVID-19 continued to impact healthcare reimbursement as the pandemic entered its second year. Yet, what’s different is that longer-term strategies and new business opportunities are emerging beyond crisis response. The Centers for Medicare & Medicaid Services (CMS) aided these plans by […]
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In-Network, Complex COVID-19 Hospitalizations Cost More Than $128K

In-Network, Complex COVID-19 Hospitalizations Cost More Than $128K

COVID-19 hospitalization costs varied by state, with the highest in-network cost averaging $128,650. According to a new FAIR Health study, COVID-19 hospitalization cost varies by state, with complex hospitalizations for COVID-19 in-network average cost maxing out at $128,650. “Behind the numbers of our COVID-19 Cost Tracker are the individuals who have contracted COVID-19. As a […]
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