Reimbursement
As the country gets ready for the roll out of the major components of the Affordable Care Act, stakeholders can look to Massachusetts, where healthcare reform was enacted seven years ago. The second installment of PwC Health Research Institute's The Massachusetts Experience, released Thursday, provides analysis on the effects of rapid insurance coverage expansion on health payers and providers in the state.
The managed care programs of several states profiled in a new Urban Institute report show a range of policy options available as new Medicaid rules and eligibility expansion (in 21 states for now) takes effect next year.
Revenue cycle integrity is critical to financial performance and will be even more so with accountable care organizations, bundled payments and other changes coming with healthcare reform.
Evan Schwartz, founding partner of New York-based law firm Quadrino Schwartz, said his organization used to see the occasional case of private insurers retrospectively auditing health care providers – they only litigated about 10 or so each year.
Most of the recent public attention paid to the federal Medicaid program has focused on the question of whether or not states will participate in the program’s expansion as allowed in the Affordable Care Act.
Steven Brill’s Time article, “Bitter Pill” sent a shock wave through the healthcare industry and prompted a response from the American Hospital Association to correct a series of mis-statements and financial assumptions.
The Medicare Trustees have projected in their annual report that the program's hospital insurance trust fund will remain solvent until 2026, two years later than predicted last year, while Social Security's solvency is estimated to last through 2033.
Health exchanges are projected to be the conduit for up to 38 million people obtaining health coverage – a huge market opportunity for payers who participate and a threat for those who cannot compete effectively. The recently solidifying requirements and the prospect of changes in the coming years create uncertainty and yet opportunity for those prepared to meet the market with flexibility, speed, and in this year, the considered basics to compete.
The GAO has concluded that the states across the country setting up health insurance exchanges will be ready for enrollment by the Oct. 1, 2013 deadline. Coverage is set to begin Jan. 1, 2014.
It took six months and a letter to the governor with a picture of their newborn for two Philadelphia graduate students to successfully enroll their son in CHIP -- and even then their premiums were miscalculated, based on a system reporting error that tripled their actual income.