Reimbursement

The Centers for Medicare and Medicaid Services is lifting former restrictions and will allow the struggling Affordable Care Act co-ops to obtain needed private capital.

Presenters will describe strategies around consumer engagement, provider contracting, and care coordination models tailored by population data, said Kevin Counihan, CEO of the Health Insurance Marketplace.

Medicaid managed care programs remains vulnerable to improper payments to providers, according to a recent Government Accountability Report to a Senate Committee on Homeland Security and Governmental Affairs, since the information needed to screen providers for inclusion in the program is often fragmented and unavailable.

Just because it's hard to achieve a payer mix that better supports a health system's bottom line, it's not impossible.

A group of more than 2,000 physicians is calling for the creation of a publicly financed, single-payer national health program that would cover all Americans for all medically necessary care. The physicians voiced their support in a proposal published Thursday in the American Journal of Public Health.

Consultants hired by the health system that owns Nantucket Cottage Hospital in Massachusetts made several errors that led to lower wages being reported to Medicare for the hospital, which could potentially lead to a $160 million drop in federal Medicare payments over the next fiscal year for facilities across the state.

The implementation of MACRA and the introduction of the Quality Payment Program is "flexible common-sense approach" for paying physicians, acting Centers for Medicare and Medicaid Services chief Andy Slavitt said at the American Hospital Association's annual membership meeting this week, though the government is actively seeking feedback on the new program.

(SPONSORED) The advent of population health presents challenges and opportunities to payers.

Humana may become the second major insurer to exit the exchange business in certain states, as it reported losses Wednesday stemming from that market.

Gallina succeeds Wayne S. DeVeydt, who, after more than a decade of service to Anthem, including 9 years in the executive vice president and chief financial officer role, decided to step down from the position effective May 31, citing family commitments and philanthropic work.