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Lawmakers are so focused on ensuring people have access to health insurance that they've completely overlooked the root causes of medical care inflation. Sean Williams (TMFUltraLong)  Jul 8, 2017 at 6:49AM Who knew healthcare could be so complicated? Apparently not the president or Congress, as both are struggling to reach a consensus as to what to do with the future of healthcare in America. Obamacare: Should it stay or should it go? Obamacare, which is officially known as the Affordable Care Act (ACA) and was signed into law by Barack Obama in March 2010, has been controversial and mostly disliked since the start. However, it's been successful in reducing the number of people without insurance. The expansion of Medicaid in 31 states, the provision of subsidies for low- and middle-income Americans, and insurance mandates that require member acceptance, regardless of pre-existing conditions, have been crucial in pushing the uninsured rate down to around 9% from 16%, according to data from the Centers for Disease Control and Prevention. At the same time, Obamacare has had its shortcomings. The Shared Responsibility Payment (SRP), which is the penalty consumers pay for not purchasing health insurance, has been far too low relative to the cost of buying an annual health plan, thus fewer young, healthy people have enrolled than expected. The risk corridor, which was a fund designed to provide money to insurers with excessive losses that had set their premiums too low, also sputtered due to insufficient funding. With little in the way of financial protections for insurers, many big names have significantly reduced their ACA plan coverage in 2017 and beyond. There are ways Obamacare can be fixed. These include adjusting the penalty on the SRP upward [...]

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Washington Post- By Alexis Pozen June 30, 2017 Alexis Pozen is a professor of Health Economics at CUNY School of Public Health and a co-author of the textbook "Navigating Health Insurance. It is no wonder so many myths about health insurance persist. The U.S. health insurance system is opaque and labyrinthine, and at times purposely so. The current debate over whether to repeal major provisions of the Affordable Care Act (ACA), otherwise known as Obamacare, comes down to whether consumers should subsidize services they never expect to use. But who pays for what, and how, is not straightforward. MYTH NO. 1 The ACA has forced millions to buy insurance they don’t want. House Speaker Paul Ryan deployed this myth when defending repeal — which the Congressional Budget Office estimated this past week would increase the number of uninsured people by 22 million by 2026. “It’s not that people are getting pushed off a plan,” Ryan said. “It’s that people will choose not to buy something they don’t like or want.” That reasoning echoes the late Supreme Court justice Antonin Scalia, who during a 2012 challenge to the ACA suggested that the law’s individual mandate started the federal government down a slippery slope. “Everybody has to buy food sooner or later,” he said. “Therefore, you can make people buy broccoli.” And no one wants broccoli, right? But both before and after the ACA, most of the uninsured consistently have reported that they want insurance. In a 2009 Department of Health and Human Services report, 48 percent of uninsured people under age 65 said they didn’t have health insurance because of the cost, 38 percent cited life changes (they had lost their jobs, left school or changed their [...]

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Confused about Medicare / Medicaid issues? Ask the experts at The Firm Services FierceHealthcare- by Leslie Small | Jun 16, 2017 4:48pm Nearly a year and a half after it was hit with government sanctions, Cigna has gotten the green light to resume selling Medicare products. Cigna can start marketing Medicare Advantage and Part D plans immediately and can begin enrolling individuals in those plans with effective dates beginning July 1, the insurer said in a Securities and Exchange Commission filing Friday. Cigna has been banned from both marketing and enrolling people in MA and Part D plans since January 2016. The Centers for Medicare & Medicaid Services said the insurer violated regulations regarding coverage determinations, appeals and grievances; Part D formulary and benefit administration; access to facilities and records; and compliance program effectiveness. These violations led to increased out-of-pocket expenses for enrollees, as well as delays or denials in receiving medical services and prescription drugs, CMS said at the time, noting such issues posed a serious threat to enrollees' health and safety. "We are a better and stronger company as a result of collaborating with CMS and investing further in our processes and technology over the past year and half,” Shawn Morris, interim president for Cigna-HealthSpring, said in a statement emailed to FierceHealthcare. “As a company that puts customers first, we look forward to continuing that partnership while delivering high-quality healthcare plans to both existing and new customers.” The process of fixing the issues cited by regulators has been a lengthy one for Cigna, and it wasn’t able to finish in time to participate in the 2017 open enrollment period for Medicare. Because of that, the insurer said in February that it expects [...]

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Credentialing, Revalidation, Medical Billing Services professionals at The Firm Services by Insurance Business 06 Jun 2017 Healthcare claims that breach the million-dollar mark continue to rise, according to Sun Life’s latest catastrophic claims report covering data from 2013-2016. Among other things, the insurance giant found that the number of multi-million-dollar claimants increased 68% from 114 to 192 during that four-year period. While multi-million-dollar cases make up a “small number” of overall claimants, the firm said they are a “greater proportion” of reimbursement dollars. In 2016, multi-million-dollar cases made up 2.2% of claimants but generated 23% of total stop-loss reimbursements. Over the four-year period, total costs for catastrophic claims reached $6.1 billion, with $2.7 billion paid in stop-loss reimbursements. The firm found that cancer dominates the top 10. Based on dollar amount and percentage of total stop-loss claims, “malignant neoplasms” and “leukemia/lymphoma/multiple myeloma (cancers)” took spots one and two on the list, representing more than a quarter (26.7%) of total stop-loss reimbursements from 2013-2016. Of the top-10 conditions, the highest claim was $3.2 million, for malignant neoplasm (cancer). For breast cancer – the most common form of cancer in the US – an average paid claim amounted to $147,100. IV medications tracked in the study pushed up costs – When looking at data on intravenous drugs, the report showed they accounted for 48% of total paid charges on the top five highest-dollar claimants. Of the 562 claimants exceeding $1 million between 2013 and 2016, 45 generated more than $1 million in high-cost intravenous medications. “Health insurance is for the unexpected. Providing full coverage for catastrophic medical events without lifetime limits as designed under the Affordable Care Act is the right thing to do,” said [...]

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Bloomberg- by John Lauerman and David Welch- June 1, 2017, 8:17 AM PDT There are two groups Community Health Systems Inc. can’t push too far: the doctors at its hospitals, and the debtholders it owes billions of dollars. Right now, the creditors are winning, and the doctors aren’t happy. In Fort Wayne, Indiana, the rancor about Community’s neglect of a local health system has gotten so bad that a group of doctors tried to get rid of corporate ownership and buy the company out. And 1,500 miles away on the island of Key West, Florida, doctors say patients are being overcharged so that Community, sometimes called CHS, can rake in cash. The two locations are among Community’s most lucrative, and their conflicts are part of the flip side of an industrywide acquisition binge over the last decade. For-profit hospital chains like Community borrowed billions to snap up rivals, facing massive debt reimbursements just as the benefits of the Affordable Care Act, known as Obamacare, began to wane. “I understand that they have billions in debt and may need to take money from this chain to service it,” said William Pond, an anesthesiologist at one of the Fort Wayne hospitals and president of the county health department’s executive board. “But it’s very disappointing to see the course that CHS is taking and the devastating effect they’re having on our community.” Once the biggest U.S. for-profit hospital chain, Community is selling off other, poorly performing facilities to pay off $2 billion of its $15 billion in debt. Yet even as the company skimps on spending and patient satisfaction lags at key facilities like Fort Wayne, its bonds are rising in value -- an indication that debtholders are betting [...]

Poll: Most older Americans want Medicare to cover long-term care

Confused about Medicare / Medicaid issues? Ask the experts at The Firm Services CBS News- AP / May 26, 2017, 7:44 AM WASHINGTON -- A growing number of Americans age 40 and older think Medicare should cover the costs of long-term care for older adults, according to a poll conducted by the Associated Press-NORC Center for Public Affairs Research. That option is unlikely to gain much traction as President Donald Trump's administration and Republicans in Congress look to cut the federal budget and repeal President Barack Obama's 2010 health care law. Most older Americans mistakenly believe they can rely on Medicare already for such care, the poll shows, while few have done much planning for their own long-term care. Things to know from the AP-NORC poll of older adults: MOST WANT MEDICARE TO PAY More than half of older Americans - 56 percent - think the federal government should devote a great deal or a lot of effort to helping people with the costs of long-term care, and another 30 percent think it should make a moderate effort to do so. According to the poll, 56 percent of Americans age 40 and over think Medicare should have a major role in paying for ongoing living assistance, up from 39 percent who said so in 2013. Majorities of both Democrats and Republicans now think Medicare should bear a large part of the burden. The poll has other signs of growing support for government involvement in providing long-term care. Seventy percent of older Americans say they favor a government-administered long-term care insurance program, up from 53 percent who said so a year ago. Most also favor tax policies to encourage long-term care planning, including tax breaks [...]

DOJ pursues UnitedHealth in second Medicare fraud suit

Axios- Bob Herman-  May 17 The Department of Justice is intervening in a second whistleblower lawsuit that alleges UnitedHealth Group, the largest health insurance and services company in the country, has defrauded the Medicare Advantage insurance program by exaggerating people's medical diagnoses to obtain more federal dollars. Why this matters: These lawsuits have some explosive allegations and threaten a company that dominates a growing and lucrative Medicare industry. In addition, the Center for Public Integrity and a federal watchdog agency have reported numerous instances of insurers manipulating a Medicare patient's "risk score" to get more money. The bottom line: This will be one of the most closely watched federal court cases in health care considering billions of taxpayer dollars are on the line. UnitedHealth is fighting back: "The complaint shows the Department of Justice fundamentally misunderstands or is deliberately ignoring how the Medicare Advantage program works. We reject these claims and will contest them vigorously," spokesman Matt Burns said. The company also said it has pursued administrative action to resolve what it views are unclear policies. Context: Nearly 20 million seniors and disabled people are enrolled in a Medicare Advantage plan, and UnitedHealth covers almost a quarter of them, or about 4.7 million. The back story: The latest whistleblower allegations come from the company's former director of finance who oversaw the Medicare Advantage business — someone with deep knowledge of the "risk adjustment" coding practices in question. Here are some eye-catching claims from the lawsuit: UnitedHealth looked at medical charts to add patient diagnoses where possible, but it did not always delete invalid diagnoses. Top executives, all the way up to UnitedHealth CEO Stephen Hemsley, were aware of an internal program that verified medical claims and [...]

House Passes Measure to Repeal and Replace the Affordable Care Act

NY Times- By THOMAS KAPLAN and ROBERT PEAR MAY 4, 2017 WASHINGTON — The House on Thursday narrowly approved legislation to repeal and replace major parts of the Affordable Care Act, as Republicans recovered from their earlier failures and moved a step closer to delivering on their promise to reshape American health care without mandated insurance coverage. The vote, 217 to 213, held on President Trump’s 105th day in office, is a significant step on what could be a long legislative road. Twenty Republicans bolted from their leadership to vote no. But the win keeps alive the party’s dream of unwinding President Barack Obama’s signature domestic achievement. The House measure faces profound uncertainty in the Senate, where a handful of Republican senators immediately rejected it, signaling that they would start work on a new version of the bill virtually from scratch. “To the extent that the House solves problems, we might borrow ideas,” said Senator Lamar Alexander of Tennessee, chairman of the Senate health committee. “We can go to conference with the House, or they can pass our bill.” Even before the vote, some Republican senators had expressed deep reservations about one of the most important provisions of the House bill, which would roll back the expansion of Medicaid under the Affordable Care Act. With $8 Billion Deal on Health Bill, House G.O.P. Leader Says ‘We Have Enough Votes’ MAY 3, 2017 But a softening of the House bill, which could help it get through the Senate, would present new problems. For any repeal measure to become law, the House and the Senate would have to agree on the language, a formidable challenge. The House voted on Thursday on a revised health care bill that would [...]

New Medicare model for paying doctors passes key test

Credentialing? Let the experts at The Firm Services complete it for you. BY LAUREN CLASON, THE HILL EXTRA - 04/13/17 03:00 PM EDT A far-reaching Medicare payment proposal cleared a crucial hurdle this week, as the federal health program seeks to reward doctors for keeping patients healthy. The pitch from the American College of Surgeons would allow more than 75 different specialty doctors to participate in Medicare’s new value-based payment system. Specialty physicians have been largely left out of the system, commonly known as MACRA after the bill that created it. Doctors would be graded and slotted into four different participation tiers — excellent, good, acceptable and unacceptable. Doctors using a less risky, lower-paying track could only reach the level of “good.” To reach “excellent” and earn bonuses through shared savings, doctors would have to be in the top 10 percent of participants. The surgeons’ group on Tuesday squeaked its proposal past the newly created Physician-Focused Payment Model Technical Advisory Committee, which is reviewing and recommending ideas to Health and Human Services Secretary Tom Price. It didn’t come easy. The surgeons pushed the committee to take a risk in greenlighting the model after the panel expressed significant reservations. The panel had raised questions about a lack of specifics with the software to be used in the program. Members eventually voted to recommend implementation, but only on a limited scale. “We’re all in a learning phase,” Medical Director for Quality and Health Policy Frank Opelka, of the surgeons' group. The model is only the second to earn the committee’s approval. “I feel like we’re building the car while we’re driving it.” The Centers for Medicare and Medicaid Services Innovation Center has approved 11 so-called [...]

UnitedHealth Bets on Medicare, Medicaid After Obamacare Exit

Bloomberg News -Zachary Tracer- April 18, 2017, 8:27 AM PDT UnitedHealth Group Inc. is doing well doing business with the U.S. government. Just not in Obamacare. The company has added more than a million customers in its federally-funded Medicare and Medicaid businesses since Dec. 31, bringing the total in the company’s public programs and seniors unit to 14.9 million, it said in a statement Tuesday announcing first-quarter results. It had a total medical membership of 49.3 million people, even after largely quitting the Affordable Care Act’s markets that many insurers once regarded as a source of millions of new customers. Shares of the biggest publicly traded U.S. health insurer gained 1 percent to $168.90 at 10:50 a.m. in New York. They’re up 31 percent in the last 12 months through Monday’s close. The company has been expanding in Medicare, where it offers private health plans for the elderly, and in Medicaid, where it helps states manage low-income individuals. Those businesses have proven to be more lucrative than Obamacare’s individual market, where UnitedHealth broadly retreated after offering plans on the health law’s exchanges in 34 states last year. The trends in UnitedHealth’s government business will help boost profits. The Minnetonka, Minnesota-based company predicted that earnings for the full year, excluding some items, will be $9.65 to $9.85 a share. That’s well above the $9.51 projected by analysts, according to an average of estimates compiled by Bloomberg, and above the company’s January forecast. First-quarter earnings excluding some items were $2.37 a share, topping the $2.17 average of analysts’ estimates. Distracted Rivals UnitedHealth has also benefited from the entanglement of its major rivals in two massive deals. Humana Inc. and Aetna Inc., the No. 2 and No. 3 sellers [...]