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Most ACOs Would Flee Medicare Program if Pushed to Take on More Risk

A huge chunk of organizations says they would leave the Medicare Shared Savings Program if they're forced to take on financial risk, which could slow the system's transition to value-based care.  It’s also unclear whether the Centers for Medicare & Medicaid Services (CMS), which oversee the program, will make any new changes. A recent letter from the agency offered [...]

By | May 25th, 2018|Did You Know?, Health Care, Insurance, Retirement, Services|0 Comments

ACA Rate Change Season Upon Us

State if VA Insurers Forecast Big Price Jumps – Other States In Same Fix Initial filings from several insurers aiming to participate on the state's ACA marketplace in 2019 show double-digit rate hikes. According to Documents Filed with Virginia Regulators: CareFirst Blue Cross Blue Shield is forecasting an average 26.6 percent boost that would affect [...]

HHS Releases Plans – Deregulation With Focus on Financial Risk … Non-ACA Plans

Providers, insurers and pharmacies can expect a major regulatory overhaul later this year.  The administration's spring 2018 unified agenda, released on Wednesday, offered a preview into various agencies' regulatory and deregulatory plans for the near future. Policy changes outlined by the Department of Health and Human Services (HHS) include reduced paperwork burdens for hospitals, greater flexibility [...]

Reimbursement, Quality Scores & Risk Adjustment Improve HCC Practices

Hierarchical condition categories (HCCs) reveal the severity, complexity and interaction of member conditions. They are used by the Centers for Medicare and Medicaid Services (CMS) to adjust risk scores that determine payment for Medicare Advantage (MA) beneficiaries. With CMS leading the way, additional government and commercial payers leverage HCCs to drive quality ratings, shared savings, [...]

By | May 18th, 2018|Health Care, Insurance, Laws, Retirement|0 Comments