Reimbursement

Healthcare providers in South Carolina will face their first payment cut in three years after Gov. Nikki Haley signed a bill repealing a 2008 proviso in state law that prevented the Department of Health and Human Services from lowering Medicaid reimbursement rates.

First, I think Accountable Care Organizations (ACOs) are a great idea. Just like I thought HMOs were a good idea in 1988 and I thought IPAs were a good idea in 1994.The whole notion of making providers accountable for balancing cost, medical necessity, appropriateness of care, and quality just has to be the answer.

For the first time, Medicare patients can see how often hospitals report serious conditions that develop during an inpatient hospital stay and possibly harm patients. The important new data about the safety of care available in America's hospitals was recently added to the Centers for Medicare & Medicaid Services' (CMS) Hospital Compare website.

Most physicians and healthcare administrators believe that healthcare, and particularly the "revenue cycle," are controlled entirely by managed-care companies.

Healthcare organizations are constantly making upgrades or replacing redundant technology, but what happens to these orphaned IT systems and the data on them? More importantly do companies even know what data is stored on these assets?

BALTIMORE - For the first time, Medicare patients can see how often hospitals report serious conditions that develop during an inpatient hospital stay and possibly harm patients with important new data about the safety of care available in America's hospitals added today to the Centers for Medicare & Medicaid Services' (CMS) Hospital Compare website. The Hospital Compare website can be accessed at www.HealthCare.gov/compare.

Many children covered under Medicaid and CHIP needing care coordination and access to care networks had difficulty getting the needed services according to a report released by the Government Accountability Office.

Kaiser Permanente this week has opened a new Center for Total Health near Capitol Hill. Kaiser executives said they hope the center will be a place or bringing together history, innovation, and state-of-the-art technology.

A new study, reported in the American Journal of Managed Care, seems likely to add more heat to the continuing medical loss ratio controversy. The Accountable Care Act effectively mandates that health insurers achieve MLRs of 85 percent for large group business and 80 percent for small group and individual business, with insurers not meeting these thresholds required to make rebates to affected policyholders. However, the ACA allows HHS to issue a waiver if the requirement would disrupt a state's insurance market.

A white paper released by MedeAnalytics shows health insurance plans should benefit from the proposed rule on accountable care organizations.