Topic: Brain Food

Medicare at 50: Past, Present & Future

Jean LeMasurier

Since its inception on July 30,1965, millions of elderly and disabled Americans have been able to obtain medical care through Medicare. Before Medicare, almost half of all Americans 65 and older had no health insurance. Today that number has dropped to a staggering 2 percent.

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MLTSS: Key to Caring for Duals

Mayling Naputi

We all want to do it: Provide the best healthcare services for our members. For our vulnerable population, this can be complicated, if not near impossible to achieve, given the current healthcare issues at hand.

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EHR Incentive Programs: Improving Access to Care

Mayling Naputi

The 2014 Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs were developed to provide financial incentives to eligible professionals, eligible hospitals, and Critical Access Hospitals (CAHs) to achieve meaningful use of certified EHR technology with the goal of improving patient care.  The programs worked to prompt healthcare providers to adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology.  In her May 18, 2015, article in RevCycleIntelligence, Jacqueline DiChiara reported by the end of 2014, EHR incentive payments reached over $28 billion with eligible hospitals receiving more than $17 billion, Medicare and Medicaid-eligible professionals collectively receiving nearly $10 billion.  However, there are some changes with the EHR Technology Incentive Program that may affect your revenue—and not in a good way.

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At the Intersection of Exhausted and Impossible

Debra Devereaux

Today, most employees and employers in all organizations struggle to do more with less…not just health plans.

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Quality Ratings: No National Standard for MCOs…Yet

Sunmi Janicek

A recent article noted five major changes in new Medicaid Managed Care rules, one pertaining to a quality ratings system. Many states have quality ratings for managed care plans, but currently there is no national standard.  Medicare has a five-star system evaluating private plans, and private plans offered through the Affordable Care Act’s (ACA’s) Health Insurance Marketplace will begin publishing quality ratings in 2016.  Ratings for Medicaid managed care plans would look similar to the Marketplace plan ratings.

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Obamacare Reinsurance and Risk Adjustment, Year One.

Jessica Smith

The much-anticipated “Summary Report on Transitional Reinsurance Payments and Permanent Risk Adjustment Transfers for the 2014 Benefit Year” has been released by the Centers for Medicare & Medicaid Services (CMS). A staggering 99.7% of Issuers were able to successfully submit data. The remaining 0.3% either did not set up an EDGE server or submitted data CMS could not use for risk adjustment calculations.  Considering the aggressive timeline Issuers were given, this completion percentage is quite remarkable. Those who failed to submit compliant risk adjustment data were slapped with a non-compliance fee, which was distributed to other Issuers in the state.

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Game Changer: Key Reforms Proposed in CMS Medicaid Rule

Mayling Naputi

You’ve got your nose to the grind stone working to meet all the waves of operational changes and requirements related to Medicare, Medicaid, Obamacare, and Health Care Reform – you literally don’t even have time to glance upward to the skies. Understandable. But it can cost you.

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