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Policy & Law

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What Can We Learn From European Hospice Care and Life Insurance Policies?

February 8, 2016 by Charlie Kimball

Worldwide, health care continues to be a hot topic for debate. No one can seem to agree on what system is best. In the United States, healthcare is different compared to other countries and many people long for a universal health care system like the types found in Europe and elsewhere around the globe. When it comes to hospice care and life insurance, there may be several things the United States can learn from Europe.[read more]

Are High-deductible Health Plans Working?

February 8, 2016 by Michael Kirsch

High-deductibles health plans are painful for consumers. The first several thousand dollars are borne by the individual. While we have an HSA (Health Savings Account), which confers a tax advantage, it is still painful to fork over wads of one's wages to cover medical expenses. Isn’t that what medical insurance is supposed to do?[read more]

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How the Healthcare Industry Has Reduced Aggravation For Patients

February 8, 2016 by Ryan Kh

The delivery of health care has changed significantly in recent years. Technological advances have made better treatment possible, while changes on the regulatory landscape and in the best practices for providing service have also had a significant impact. As a result, patients' lives are improving dramatically.[read more]

Future Outlook: Medicare Advantage Plans & Risk Adjustment

February 5, 2016 by David Harlow

Over the past couple of decades, the federal government has come to recognize that not every Medicare beneficiary’s health care services in a given year cost the same as every other beneficiary’s. For beneficiaries enrolled in traditional Medicare, the government pays most of the cost of that care — whether it’s a lot or a little, whether the beneficiary in question is relatively healthy or living with multiple chronic conditions.[read more]

In Medicare Advantage, providers are becoming payers

February 5, 2016 by David E Williams

Accountable Care Organizations enable providers of care to take on some of the functions of health plans and to receive some of the financial rewards as well as the risk. But at least on the Medicare side it can be fairly indirect, with patients “attributed” to providers rather than assigned and little formal ability to keep a patient within a single provider system.[read more]

Healthcare Patient Payment Liability Just Ain’t What it Used to Be

February 3, 2016 by Phil C. Solomon

The ACA, with its comprehensive health insurance reforms, has initiated a growing trend that has placed more financial accountability on the shoulders of consumers. Hospitals and health systems are embracing consumerism and are preparing for greater levels of out-of-pocket (OOP) patient liability.[read more]

Individuals’ Rights to Their Health Information: The Federales Awaken

February 3, 2016 by David Harlow
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For purposes of the present discussion, I am interested in the patient right to medical record information included in HIPAA, rather than privacy and security protections for patient data. The core elements of the HIPAA rule relevant to patient access to medical records have not changed since the rule was originally promulgated.[read more]

Like I said: United’s ACA exchange departure is no big deal

January 29, 2016 by David E Williams

Robert Wood Johnson Foundation funded an Urban Institute study to determine how Obamacare marketplaces are being impacted by the withdrawal of United Healthcare and the failure of some of the CO-OP plans. I’m grateful for the data but as it turns out their findings line up with what I wrote more than two months ago...[read more]

Are House Calls for You?

January 28, 2016 by Michael Jones
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Not sure which practice model is right for you? An increasing number of physicians are looking toward a growing specialty that has its roots in the past. If you don’t think doctors make house calls anymore, think again.[read more]

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Why Clinicians Need to Embrace Their HIT Teams

January 25, 2016 by Edgar Wilson

Information silos grow from professional silos. Reconnecting means redefining membership of the healthcare team to include new occupations.[read more]

5 Healthcare Industry Issues of 2016

January 25, 2016 by Moira O'Connell

It’s only the beginning of 2016, but we've been keeping a close eye on the upcoming healthcare trends for the year. Thanks to the annual Healthcare Issues report by the Health Research Institute of PricewaterhouseCooper (that highlights 10 major issues for the healthcare industry), we are able to take a deeper look into what the New Year may hold for the healthcare industry as a whole. From mobile health to Mergers and Acquisitions, let’s look at the first 5 healthcare industry issues bound to take root this year.[read more]

CMS for Medicare Advantage Risk Adjustment Update

January 22, 2016 by Phil C. Solomon

Medicare’s Recovery Audit Contractor (RAC) program was implemented nationwide for Medicare Parts A and B in January 2010 The Affordable Care Act calls for the program to be expanded to cover Medicare Advantage plans, and last month CMS released a draft Scope of Work to “solicit comment on, and interest in CMS entering into a contract with RACs to identify underpayments and overpayments, and recouping overpayments associated with diagnosis data submitted to the Centers for Medicare & Medicaid Services (CMS) by Medicare Advantage Organizations.”[read more]