Tag: Affordable Care Act

Prior Authorization reforms

CMS Prior Authorization Reforms: A Step Forward, But More Needed

The updated CMS regulations on prior authorization have been lauded as a significant step toward reducing administrative burdens for physicians. However, critics argue that the changes fall short of addressing the broader issues. Accelerating Prior Authorization and Enhancing Transparency Issued in January, these regulations mandate federally regulated health plans to enhance electronic health information exchange […]
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Top 4 Challenges in Insurance Reimbursement Faced by Physicians

Access to beneficial healthcare is largely tied to insurance reimbursements for many Americans. Yet, despite their significance, physicians encounter various obstacles in obtaining these payments. Challenges involve inconsistent reimbursement schedules, payment audits, billing errors, unforeseen denials, lengthy appeals, and services falling outside coverage. These issues can hinder timely care, disrupt service continuity, and leave medical […]
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Value-Based Care Catching up to Fee-For-Service

Value-Based Care Catching up to Fee-For-Service

Outcomes-based models are spreading, but fee-for-service still dominates payment landscape. Is value-based care having a moment? Health care policy experts and institutions have long agreed that fee-for-service (FFS) medicine is wasteful, outmoded and at least partially responsible for the U.S. spending far more than peer nations on health care, but with outcomes that are no […]
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AHIP warns proposed ACA exchange rule could threaten market’s growing stability

AHIP warns proposed ACA exchange rule could threaten market’s growing stability

  AHIP, the top lobbying organization for commercial insurers, is warning the feds that provisions in its proposed rule governing the Affordable Care Act’s exchanges for 2023 could “undermine” the growing stability there. For instance, the group says in comments (PDF) submitted late Thursday that potential changes to requirements for essential health benefits would limit […]
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How The Affordable Care Act Impacted Small Group Coverage Trends

How The Affordable Care Act Impacted Small Group Coverage Trends

Small group coverage did not pursue the trends that many experts anticipated after the Affordable Care Act went into effect. From 2013 to 2020, small group coverage has maintained a fairly stable environment, researchers from the Urban Institute found. The researchers used the Medical Expenditure Panel Survey Insurance Component (MEPS-IC) in order to assess changes […]
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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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Physicians Collect More From Surprise Medical Bills in ED

Physicians Collect More From Surprise Medical Bills in ED

  Physicians in a hospital’s emergency department (ED) collected significantly more of the charged amount for likely surprise medical bills compared to other patient cases, a new study in Health Affairs reveals. In the event of a likely surprise medical bill, physicians collected 65 percent of the charged amount compared with just 52 percent for other cases. Researchers also […]
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CMS Finalizes How It Will Cut Medicaid DSH Payments

CMS Finalizes How It Will Cut Medicaid DSH Payments

The Senate passed a continuing resolution that would temporarily stop the implementation of Medicaid DSH payment cuts until Nov. 22, 2019. CMS on Monday finalized a rule that will reduce Medicaid Disproportionate Share Hospital (DSH) payments by $4 billion next year and $8 billion a year until fiscal year 2025. The new final rule will implement Medicaid DSH payment […]
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