Reimbursement

GOP governors mull exchange options; NAIC compiling list of questions for HHS on HIX implementation; and Conn. group urges state exchange to be an "active purchaser" in this week's HIX Digest.

The U.S. Department of Health and Human Services (HHS) will need to place a lot of emphasis on implementing the Affordable Care Act (ACA) in the coming year, according to the Office of Inspector General's (OIG) annual summary of management and performance challenges facing the agency, released this week.

More than half of all Medicare claims denial appeals are overturned by administrative law judges according to a recent report by the Office of Inspector General.

Data released last week for the S&P Healthcare Economic Composite Index shows that the average cost of healthcare services increased 5.06 percent over the preceding 12 months ending in September, a significant drop from the annual growth rate of 5.7 percent reported in August.

More than half of all Medicare claims denial appeals are overturned by administrative law judges according to a recent report by the HHS Office of the Inspector General.

A recent New England Journal of Medicine (NEJM) study points to a new pilot program that offers payment models that may encourage hospitals to better coordinate transitions of care, resulting in fewer readmissions.

At a time when the nursing home industry is lobbying Congress to avoid cuts in Medicare payments, a federal watchdog agency is reporting that taxpayers overpaid nursing homes $1.5 billion.

In an effort to accelerate the development of innovative care models within their respective health systems, Piedmont Healthcare and WellStar Health System announced earlier this week the joint formation of the Georgia Health Collaborative, the first such organization in the state.

Much has been written and said about the effect of the election on the implementation of federal health reform initiatives.  The commentariat, including the blogerati and twitterati wings, have focused on the budget battles of the future to come from Capitol Hill, the flurry of regulations to come from HHS, and the last stand of the boys in red in certain state capitals around the country against implementation of health insurance exchanges and Medicaid expansion under the ACA.

Every hospital executive wants to keep healthcare costs down which is why as hospitals are integrating provisions of healthcare reform into their care model, affiliating with and developing primary care clinics is of growing interest.