Health Plan Payment and Reimbursement

Exemptions to Anthem’s ED Policy

Anthem will not deny an ED claim based on the prudent layperson standard if certain conditions apply.

HFMA July 12, 2018

MA Gets Better Outcomes Despite Sicker Enrollees: Study

July 10—Contrary to general belief, Medicare Advantage (MA) plan enrollees are initially sicker than those in fee-for-service (FFS) Medicare, according to new research. And once enrolled, MA beneficiaries get better care at a lower cost.

Rich Daly July 11, 2018

Pilot to Offer APM Bonuses to Physicians in Medicare Advantage

July 3—Medicare plans to launch a pilot—as soon as this year—to allow physicians paid through Medicare Advantage value-based arrangements to qualify for the same bonuses as those working in advanced alternative payment models.

Rich Daly July 3, 2018

Definition of “Employer” under Section 3(5) of ERISA – Association Health Plans Final Rule Executive Summary

This document summarizes the Employee Benefits Security Administration's Association Health Plans final rule, published in the June 21, 2018, Federal Register.

HFMA July 3, 2018

Rejecting Hospital Concerns, Administration Expands Association Plans

June 19—Despite calls from major hospital groups to drop a proposed expansion of association health plans (AHPs), the Trump administration has finalized those rules.

Rich Daly June 20, 2018

June 4-8: High-Deductible Health Plans Draw Congressional Scrutiny

May 31—Amid record-breaking enrollment in high-deductible health plans (HDHPs), a congressional panel plans to examine their growth and consider policies to bolster health savings accounts.

Rich Daly May 31, 2018

How MA Plans Are Changing VBID Approaches

May 18—Medicare Advantage (MA) plans are evolving their approaches in the expanding Medicare pilot for value-based insurance design (VBID).

Rich Daly May 21, 2018

A Look at Two Blues’ Distinct Approaches to Changing the Healthcare Model

May 16—Two dominant not-for-profit health plans—both Blue Cross insurers—are moving aggressively in very different directions.

Rich Daly May 17, 2018

Ask the Experts: Credit Balances

How do other Florida hospitals initiate and work credit balances?

HFMA May 8, 2018

New MA Rules Benefit Provider-Sponsored Plans

April 18—Recently announced Medicare Advantage (MA) rates and rule changes could help sometimes-struggling provider-sponsored plans improve their performance.

Rich Daly April 19, 2018
googletag.cmd.push( function () { googletag.display( 'hfma-gpt-leaderboard' ); } );