Reimbursement

Bloomberg highlights the challenges many of the newly insured will have in paying for coverage, even with the substantial subsidies available to those with lower incomes.

Hospitals and healthcare systems across the country will soon be facing large cuts in Medicare if the U.S. Congress cannot reach an agreement on an alternative deficit reduction plan in order to avert the so-called fiscal cliff, therefore it's a good idea for these organizations to start being proactive.

Missouri governor pushes for Medicaid expansion; Kansas still awaits word from feds on KanCare overhaul; and New Jersey bill would limit insurers' ability to make reimbursement cuts in this week's Medicaid Digest.

With the U.S. presidential election now squarely in the rearview mirror, the focus shifts to the implementation of key facets of the Patient Protection and Affordable Care Act (PPACA). No portion of the law will be under greater scrutiny than the introduction of government-sponsored health insurance exchanges, scheduled to begin accepting open enrollment in October 2013, with an implementation date of January 1, 2014.

The Federal Trade Commission (FTC) is challenging two hospital acquisitions, one in Ohio and another in Georgia that's currently under review by the U.S. Supreme Court, and the outcomes may establish precedent for post-health reform provider consolidation.

Increased adoption of consumer-directed health plans (CDHPs) and an increased emphasis on employee health management programs helped U.S. employers hold their health benefit cost increases to an average of 4.1 percent in 2012, the lowest average annual increase since 1997, according to a new survey from global consulting firm Mercer.

The Centers for Medicare and Medicaid Services will have to manage and analyze double the volume of Medicare data and triple the terabytes of Medicaid data after health reform is fully in place. 

One of several private health insurance exchanges that has evolved over the past several years, Buffalo-based benefits exchange company Liazon garnered some attention recently when it was ranked number 132 on the Inc. 5000 list of fastest growing companies.

The average premium for family health plans sold through eHealthInsurance.com was $412 a month in 2012, down slightly from 2011, amid "a relative flattening of the cost curve," eHealth Inc. CEO Gary Lauer said.

In a new study published in the Journal of General Internal Medicine, it was found that after examining patients suffering from pneumonia and heart failure, a broad range of social factors affect the risk of post-discharge readmission and mortality.