Reimbursement

The American Taxpayer Relief Act of 2012 became law on Jan. 2. Among its many provisions, the law postpones a scheduled 26.5 percent payment cut for physicians and other practitioners who treat Medicare patients, but payments to physicians may be temporarily held.

Even thought the recent fiscal cliff compromise brokered in the Senate will only patch two months, the legislation has permanently cut more than $1.4 billion in funding that was earmarked to help consumer operated and oriented (CO-OP) health plans become established in all 50 states.

If one person could be credited with first conceptualizing and promoting the idea of health insurance exchanges, it's probably Alain Enthoven, an 82-year-old economist and retired Stanford University business professor.

Now that Obamacare is likely here to stay, it's time to get serious about reforming key elements of our healthcare system. One area that deserves attention is the simplification of administrative processes that weigh on every transaction in healthcare. While it is not a new concept, it is one that is ready for prime time.

A federal judge in Atlanta has temporarily blocked Georgia's new prompt payment law for self-funded plans' third party administrators, siding with America's Health Insurance Plans (AHIP) in citing the preemption of federal law.

With the implementation of the Affordable Care Act (ACA) over the next few years there are going to be several new fees for both health insurers and employers sponsoring self-insured health plans that go into effect.

Gene Lindsey, MD, president and CEO of Newton, Mass.-based Atrius Health shares his thoughts on accountable care organizations (ACOs) and talks about Atrius' experience as a Pioneer ACO.

Despite objections of a large block of fiscally conservative Republicans, the House yesterday approved a fiscal cliff compromise crafted in the Senate in the first hours of the new year by a vote of 257 to 167, which also averted steep Medicare payment cuts to doctors for yet another year.

Insurers looking to compete in the ever-changing healthcare marketplace will continue to focus on technology in 2013 both as a means of improving payment models and partnerships with provider groups and as the industry looks to make the transition to consumer-focused products it will offer on health insurance exchanges.

The Department of Health and Human Services estimates that some 25 million Americans will be buying health insurance through Affordable Care Act-certified exchanges within the next few years. But that and a lot of other HIX outcomes remain to be seen.