Reimbursement

I was only a little bit surprised to read The Doctor’s Office as Union Shop, which blames the Affordable Care Act (ACA) for ushering in “a potentially radical factor in the transformation of health care –the doctor as union worker.”

Humana reported its earnings sank 3.5 percent in the fourth quarter 2012 from the previous year, as the insurer made investments to build its own integrated care network and reported more than $75 million in flu-related expenses.

For the third time since it first introduced its plans to require women's preventive health services including coverage for contraception under employer-sponsored health plans, the Department of Health and Human Services on Friday announced a modified set of proposed rules aimed at allaying the objections of religious organizations to the mandate.

For Medicare Advantage and prescription drug plans, the pressure is on to improve quality or miss out on incentives under the Centers for Medicare & Medicaid Services (CMS). Specifically, under the agency's Five Star Quality Rating System, plans that achieve and maintain a rating of 4.5 or above will have the opportunity to enroll beneficiaries throughout the 2013 plan year under a newly created special election period.

On Thursday, the Centers for Medicare & Medicaid Services (CMS) announced it had selected more than 500 healthcare organizations to participate in its Bundled Payment for Care Improvement initiative, a program to test how bundling payments for episodes of care can improve care coordination and lower overall Medicare expenditures.

The earlier hospitals begin to plan and strategize for how they will handle the healthcare environment once health insurance exchanges are operational, the better, said Purva Rawal, senior manager of health reform at Avalere Health, during a webinar Thursday.

Now that the Affordable Care Act has survived the Supreme Court ruling and the presidential election, one of last year's other big issues is moving to the forefront for 2013: reimbursements.

Managed care insurer Health Net reported 2012 fourth quarter earnings down 91 percent from the previous year, after litigation, severance costs and declines in commercial enrollment.

The Green Mountain Care Board (GMCB) recently outlined its second year of work as it helps guide the state toward a publicly financed single payer healthcare system by 2017.

Web insurance marketplace and health insurance exchange company Connecture announced earlier this month that it had acquired DRX (formerly DestinationRx), in a deal that will join two companies that offer online enrollment and insurance marketplaces for commercial plans and government insurers alike.