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Tax bill will not seek repeal of individual health insurance mandate

The Hill- BY PETER SULLIVAN - 11/02/17 09:51 AM EDT The tax reform bill to be released Thursday will not include a repeal of ObamaCare's individual mandate, sources say, despite President Trump proposing the idea on Wednesday. Repealing the mandate would introduce a whole new area of controversy into the bill, and many Republicans think tax reform is hard enough without adding in health care. Still, it is possible the idea could come back down the road, given that some Republicans are still pushing. Rep. Kristi Noem (R-S.D.), a member of the House Ways and Means Committee, said Wednesday night that she did not think mandate repeal would be included "just because we didn't have unanimous agreement on the committee." Sen. Tom Cotton (R-Ark.) has been the main proponent of the idea and talked with Trump about it over the weekend. Repealing the mandate would save around $400 billion, which could be used to help pay for tax cuts, but the Congressional Budget Office also says 15 million more people would be uninsured and premiums would rise 20 percent. Ways and Means Committee Chairman Kevin Brady (R-Texas) said earlier this week, though, that he did not want to include mandate repeal because he fears it will jeopardize the tax bill since the Senate has been unable to deliver on health-care reform. Rep. Mark Meadows (R-N.C.), the chairman of the conservative House Freedom Caucus, said Wednesday night that he would push for including mandate repeal and that he thought "ultimately" it would be included in the bill. Meadows said he has talked to Cotton. Rep. Mark Walker (R-N.C.), the conservative Republican Study Committee chairman, said he had discussed the idea at an RSC meeting with National Economic [...]

By |November 2nd, 2017|Blog, Consulting, doctor, doctor Credentialing, Healthcare Professionals, ICD-10, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, medicare claims, Obamacare, Physician Credentialing|Comments Off on Tax bill will not seek repeal of individual health insurance mandate

Wall Street Sees a CVS, Aetna Deal as a Revolutionary Defense

Bloomberg - By Cristin Flanagan October 27, 2017, 7:56 AM PDT Speculation that CVS Health Corp may be making a play to buy Aetna Inc yesterday followed hot on the heels of report that Amazon Inc. had received pharmacy-wholesaler licenses in a dozen states. While a pharmacy acquiring a health insurer may be an unusual step, analysts see it as potentially bold move to fend of the looming Amazon threat and enter an “evolutionary and revolutionary” new world in health care. Others, however, saw an expensive deal and question whether Aetna would be a willing seller. CVS and Aetna shares both fell on Friday morning, down as much as 4.7 percent and 2.9 percent respectively. “We see this potential deal as both evolutionary and revolutionary given the dynamic healthcare environment and push toward consumerism coupled with a challenged retail backdrop and the need to combat a looming Amazon threat. In our opinion, the merits of the deal and potential new model is conceptually compelling, with the biggest questions admittedly, execution, integration, and the structure of the deal. Based on our analysis, we estimate the deal could be 24 cents per share, or 3.7 percent accretive to CVS in year one with greater upside over time if the combined entity successfully manages down healthcare cost. “Could they even do the deal? It’s possible. The reported deal could imply a takeout value of 12.4x trailing 12 months (TTM) Ebitda by our estimate. Based on CVS’ acquisitions of Caremark (in 2006 for 11.8x TTM Ebitda), and Omnicare (in 2015 for 22.0x TTM Ebitda), this deal could be in bounds.” “We think a CVS / AET combination makes a lot of sense. We would imagine a scenario that CVS expands its [...]

I.R.S. Says It Will Reject Tax Returns that Lack Health Insurance Disclosure

NY Times- Health - By REED ABELSON-OCT. 20, 2017 Despite President Trump’s pronouncements, not only is Obamacare not dead, there are signs that his administration is keeping it alive. In the latest signal that the Affordable Care Act is still law, the Internal Revenue Service said this week that it is taking steps to enforce the most controversial provision: the tax penalty people face if they refuse to obtain health insurance. Next year, for the first time, the I.R.S. will reject your tax return when filed electronically if you do not complete the information required about whether you have coverage, including whether you are exempt from the so-called individual mandate or will pay the penalty. If you file your tax return on paper, the agency said it could suspend processing of the return and delay any refund you might be owed. The agency’s new guidance for tax professionals seems to contradict Mr. Trump’s first executive order, on Inauguration Day, which broadly instructed various agencies to scale back the regulatory reach of the federal health care law. As part of his promise to overturn the law, the executive order hinted that the new administration could stop enforcing the mandate that people have insurance or pay a tax penalty, which proponents have long argued is critical to the law’s success by requiring young and healthy people to enroll. The I.R.S.’s guidance makes it clear that taxpayers cannot simply ignore the Affordable Care Act. While the penalty applies only to people without insurance, all taxpayers are required to say whether they have coverage. Legal experts say the I.R.S. has been clear that the law was in effect, despite repeated efforts by Mr. Trump and Republican lawmakers to repeal it. [...]

By |October 22nd, 2017|Blog, doctor, doctor Credentialing, Healthcare Professionals, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, medicare claims, Obamacare, Physician Credentialing|Comments Off on I.R.S. Says It Will Reject Tax Returns that Lack Health Insurance Disclosure

Trump to Scrap Critical Health Care Subsidies, Hitting Obamacare Again

The New York Times- By ROBERT PEAR, MAGGIE HABERMAN and REED ABELSON -OCT. 12, 2017 WASHINGTON — President Trump will scrap subsidies to health insurance companies that help pay out-of-pocket costs of low-income people, the White House said late Thursday. His plans were disclosed hours after the president ordered potentially sweeping changes in the nation’s insurance system, including sales of cheaper policies with fewer benefits and fewer protections for consumers. The twin hits to the Affordable Care Act could unravel President Barack Obama’s signature domestic achievement, sending insurance premiums soaring and insurance companies fleeing from the health law’s online marketplaces. After Republicans failed to repeal the health law in Congress, Mr. Trump appears determined to dismantle it on his own. Without the subsidies, insurance markets could quickly unravel. Insurers have said they will need much higher premiums and may pull out of the insurance exchanges created under the Affordable Care Act if the subsidies were cut off. Known as cost-sharing reduction payments, the subsidies were expected to total $9 billion in the coming year and nearly $100 billion in the coming decade. “The government cannot lawfully make the cost-sharing reduction payments,” the White House said in a statement. It concluded that “Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people.” In a joint statement, the top Democrats in Congress, Senator Chuck Schumer of New York and Representative Nancy Pelosi of California, said Mr. Trump had “apparently decided to punish the American people for his inability to improve our health care system.” “It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America,” they said. “Make no [...]

By |October 13th, 2017|Blog, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Obamacare, Physician Credentialing|Comments Off on Trump to Scrap Critical Health Care Subsidies, Hitting Obamacare Again

CMS Reveals New Medicare Card Design

CMS.GOV-  SEPTEMBER 14, 2017  Today, the Centers for Medicare & Medicaid Services (CMS) gave the public its first look at the newly designed Medicare card. The new Medicare card contains a unique, randomly-assigned number that replaces the current Social Security-based number. CMS will begin mailing the new cards to people with Medicare benefits in April 2018 to meet the statutory deadline for replacing all existing Medicare cards by April 2019. In addition to today’s announcement, people with Medicare will also be able to see the design of the new Medicare card in the 2018 Medicare & You Handbook. The handbooks are being mailed and will arrive throughout September. “The goal of the initiative to remove Social Security numbers from Medicare cards is to help prevent fraud, combat identify theft, and safeguard taxpayer dollars,” said CMS Administrator Seema Verma. “We’re very excited to share the new design.” CMS has assigned all people with Medicare benefits a new, unique Medicare number, which contains a combination of numbers and uppercase letters. People with Medicare will receive a new Medicare card in the mail, and will be instructed to safely and securely destroy their current Medicare card and keep their new Medicare number confidential. Issuance of the new number will not change benefits that people with Medicare receive. Healthcare providers and people with Medicare will be able to use secure look-up tools that will allow quick access to the new Medicare numbers when needed. There will also be a 21-month transition period where doctors, healthcare providers, and suppliers will be able to use either their current SSN-based Medicare Number or their new, unique Medicare number, to ease the transition. This initiative takes important steps towards protecting the identities of [...]

AnMed Health to pay $7 million to settle False Claims Act allegations

WSPA Channel 7 News Columbia SC- Published: September 27, 2017, 10:58 am Updated: September 27, 2017, 12:37 pm COLUMBIA, SC (WSPA) – AnMed Health has agreed to pay over $7 million to settle allegations that it submitted false Medicare claims. A news release from the U.S. Attorney’s Office states “AnMed Heath knowingly disregarded the statutory conditions for submitting claims to the Medicare program for a variety of services, including radiation oncology services, emergency department services, and clinic services.” Prosecutors allege “AnMed Health billed for radiation oncology services for Medicare patients when a qualified practitioner was not immediately available to provide assistance and direction throughout the radiation procedure, as required by Medicare regulations.” AnMed is also accused of billing a minor care clinic as if it was an emergency department and billed emergency department services as if they were provided by a physician, but were rendered by mid-level providers, according to the news release. Prosecutors say those practices resulted in higher reimbursements to AnMed Health. The allegations came to light following a lawsuit filed by Linda Jainniney. Prosecutors say Jainniney is a whistleblower who used to work for AnMed Health. “This is another example of how the False Claims Act whistleblower provisions help protect the public’s interest,” U.S. Attorney John Horn said in a statement. “It also reflects our ongoing commitment to safeguard our federal health care programs and the vital care that they provide.” “Protecting people with Medicare and guarding health resources are top priorities,” said Derrick L. Jackson, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “Provider organizations seeking to increase profits at the expense of patients and taxpayers should expect such plans to [...]

By |September 28th, 2017|Blog, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, ICD-10, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, medicare claims, Physician Credentialing, Staff Training|Comments Off on AnMed Health to pay $7 million to settle False Claims Act allegations

If Republicans Revive Health Care Again, This Is What It Could Mean For Your State

NPR- September 22, 20173:19 PM ET -Danielle Kurtzleben John McCain on Friday imperiled Republicans' latest Affordable Care Act repeal and replace effort when he said he "cannot in good conscience" support the so-called Graham-Cassidy bill. But McCain did also say he could at some point support the substance of his fellow Republicans' proposal. "I would consider supporting legislation similar to that offered by my friends Sens. [Lindsey] Graham and [Bill] Cassidy were it the product of extensive hearings, debate and amendment," McCain said. "But that has not been the case." That's notable because for the first time since Trump became president, there actually seemed to be some real ideological unity around a repeal-and-replace effort from Republicans. Graham-Cassidy Health Bill Would Shift Funds From States That Expanded Medicaid If it is revived — and this effort isn't quite dead yet, because other GOP holdouts haven't stated their unequivocal opposition publicly — the Graham-Cassidy bill very well may be the foundation of how the health care system is reshaped. What would it mean for where you live? We take a look A big selling point of Graham-Cassidy, according to its proponents, is flexibility for states. In place of the federal dollars that fund Obamacare's subsidies and Medicaid expansion, Graham-Cassidy, which under the latest GOP proposal would be law in 2020, would give states block grants. Those are big chunks of money given directly to states, which would have broad discretion in how to spend them. But what's important is that those block grants would be less money than the total money that states are getting for Obamacare right now. Graham-Cassidy would eliminate the premiums that help people pay for their health insurance and the payments helping insurance companies [...]

By |September 23rd, 2017|Blog, Doctor, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Obamacare, Optometrist, Physician Credentialing|Comments Off on If Republicans Revive Health Care Again, This Is What It Could Mean For Your State

Medicare for All or State Control: Health Care Plans Go to Extremes

NY Times - By ROBERT PEAR- SEPT. 13, 2017 WASHINGTON — In one Senate office building, some of the leading lights of the Democratic Party gathered Wednesday to embrace what was once a proposal only of the far left: a huge expansion of Medicare, large enough to open the popular, government-run health program to all Americans. In another Senate office building, a smaller but equally adamant group of Republican senators stood together to take one last stab at dismantling the Affordable Care Act. They proposed instead to send each state a lump sum of federal money, along with sweeping new discretion over how to use it. Important elements in both parties are trying to move beyond President Barack Obama’s health care law, which has always been a complicated, politically difficult mix of government and private health insurance. But they are moving in radically different directions. The proposals appeared to have only one thing in common: Neither is likely to be enacted any time soon. Senator Bernie Sanders of Vermont, the onetime candidate for the Democratic presidential nomination, proposed what he called “a Medicare-for-all, single-payer health care system,” and he said 16 Democratic senators supported it. Those included Elizabeth Warren of Massachusetts, Cory Booker of New Jersey, Kirsten E. Gillibrand of New York and Kamala Harris of California — all names on the list of possible candidates for president in 2020. “Instead of wasting hundreds of billions of dollars trying to administer an enormously complicated system of hundreds of separate insurance plans, there would be one insurance plan for the American people with one single payer,” said Mr. Sanders, the ringmaster of an event that felt like a political rally, with banners and placards, consumers and patients, [...]

Will Congress Continue Health Care For 9 Million Children?

NPR- September 6, 20175:38 PM ET- PHIL GALEWITZ A popular federal-state program that provides health coverage to millions of children in lower- and middle-class families is up for renewal Sept. 30. But with a deeply divided Congress, some health advocates fear that the Children's Health Insurance Program could be in jeopardy or that conservative lawmakers will seek changes to limit the program's reach. Other financial priorities this month include extending the nation's debt ceiling, finding money for the Hurricane Harvey cleanup and keeping the government open. "With all that is on Congress' plate, I am very worried that a strong, wildly successful program with strong public support will get lost in the shuffle and force states to begin the process of winding down CHIP," said Bruce Lesley, president of the advocacy group First Focus. The program covers more than 9 million kids — typically from families not poor enough to qualify for Medicaid, the state-federal program that covers health care for people with low incomes. Income eligibility levels for CHIP vary widely among states, though most set thresholds at or below 200 percent of the poverty level — about $49,000 for a family of four. Unlike Medicaid, CHIP is usually not free to participants. Enrolled families pay an average premium of about $127 a year. Since CHIP's enactment, the share of uninsured children in the U.S. fell from 13.9 percent in 1997 to 4.5 percent in 2015, according to the Medicaid and CHIP Payment and Access Commission. The 20-year-old program has bipartisan support. One of its original sponsors is Sen. Orrin Hatch, R-Utah, chairman of the Finance Committee, which has scheduled a hearing on reauthorization Thursday. It's possible in the jam-packed legislative calendar this month that other [...]

States hurry to fix health-insurance markets

The Economist- Aug 31st 2017 | WASHINGTON, DC Though insurers remain, Obamacare is teetering in places NOT long ago, America’s health-insurance markets seemed to be drying up. In June 49 counties lacked any willing providers for the “individual market”, which serves 18m Americans who are not covered by an employer or the government. The Affordable Care Act, Barack Obama’s health-care law, seemed to have failed these places. Frantic efforts by state officials have filled the gaps: Nevada’s governor claims to have interrupted a hiking trip with his daughter to broker a deal covering most of his state. The last empty market, in Ohio, gained an insurer on August 24th. But failure has not yet been averted. With health reform stalled in Congress, several states are rushing to patch things up themselves before insurance for 2018 goes on sale in November. Obamacare’s markets were always likely to limp on rather than collapse utterly, because they have a blank cheque from the federal government. The law caps premiums for buyers who earn less than four times the poverty line (this year the cut-off is $48,240 for an individual). No matter how high premiums rise and how many healthy people leave the market, some subsidised enrollees, who have already reached their premium caps, will keep buying. The only surprise is that it has taken so much cajoling to get insurers to run monopolies in markets buttressed by such generous government support. Yet rising premiums are a big problem for many of the 9m Americans who buy insurance for themselves without any government help. In Iowa about 28,000 people are on the hook, according to Doug Ommen, the state’s insurance commissioner. As things stand, only one firm, Medica, will sell [...]