On Monday the Centers for Medicare and Medicaid Services (CMS) issued a proposal to relieve healthcare providers of Medicare's unnecessary compliance burdens.
According to the CMS press release, the updates would save healthcare providers...National News
Predicted to grow at 5.5 percent annually, healthcare spending has consequences for the nation's economy.
In 2016, healthcare spending was 18 percent of GDP or $3.3 trillion. New predictions for healthcare spending mean such growth will outpace GDP over the same period.
Moody's Assistant Vice President Rebecca Karnovitz told Health...Arizona News
Filed on September 12, the lawsuit alleges the state hospital impeded the ACDL's ability to monitor the conditions of facilities housing individuals with mental illness, and investigate incidents of abuse and neglect in those facilities.
Under the Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act, ACDL is...Arizona News
On Monday the Justice department gave the $52 billion merger between Cigna and Express Scripts a green light. The health insurance giant and massive pharmacy benefits manager aim to cut costs of care.
The deal passed a shareholder vote toward the end of August but the DOJ's vote was the last major obstacle to clear, all that...Arizona News
The healthcare cost increases Americans have seen in the past few years in the Affordable Care Act’s (ACA) individual marketplace are coming to a halt as insurers get to know their risk pool.
Studies reveal premiums on the individual ACA exchange will experience less than a five percent increase, a slowdown considering in 2018...Arizona News
The demographics of the medical field are changing as more and more women are entering the field and filling power positions, pushing the industry in the direction of equal-opportunity.
An Association of American Medical Colleges study revealed in 2017 more women than men were enrolled in U.S. medical schools. Of the new...Arizona News
The Phoenix-based non-profit and the valley’s largest health system is seeking to fill 1,500 positions at a time when nursing shortages are of national concern. Throughout the month of September, Banner Health will host various career open houses to fill out its nursing staff, leadership and entry-level positions as well as...National News
A case filed in Washington, D.C. last week aims to stop the expansion of the Trump administration’s short-term insurance plans, claiming they will hurt the Affordable Care Act (ACA).
Short-term insurance sneaks around ACA requirements and does not have protections like guarantee issue and community rating (ACA mandates); a...Arizona News
Grant funding provided by the Department of Health and Human Services (DHS), Substance Abuse and Mental Health Services Administration (SAMHSA).
AHCCCS will administer the grant and work with other state agencies, health plans, and community partners to address specific initiatives. This is the first installment of a two-year grant...White Papers, E books, Reports and more
The report examines the accuracy of the current CMS risk adjustment model for beneficiaries with functional limitations and the potential benefits of accounting for functional status in MA risk adjustment; and the potential challenges of accounting for functional status in risk adjustment.
Beneficiaries in poorer health are generally...National News
UnitedHealthcare won its case over a 2014 rule implemented by the Centers for Medicare and Medicaid Services (CMS) requiring that Medicare Advantage organizations report and return any identified overpayments. The rule was deemed arbitrary and capricious.
U.S. District Court Judge Rosemary Collyer vacated the rule in its entirety,...Arizona News
MA insurers are auditing patient's medical charts to find more diagnosis codes in effort to get larger reimbursements from the Medicare program. The business of insurance encourages the documentation of all possible diagnoses to generate billions in profits. Modern Healthcare cites an Anthem lawsuit as an example of the returns...Arizona News
The Parson v. Ryan saga continues to drag on for nearly five years. Before retirement in June, U.S. Magistrate Judge David Duncan issued a series of orders in response to a lack of progress from the Department of Corrections (DOC) and Corizon.
In a statement, CEO of Corizon Health Stephen Rector said the court failed to recognize...Arizona News
The Department of Veterans Affairs Office of Inspector General (OIG) released an audit on Thursday, Sept. 6 revealing over $101 million in overpayments during a one-year period to two contracted third party administrators under the Veterans Choice Program: Health Net Federal Services and TriWest Healthcare Alliance Corporation.
An...Arizona News
As an alternative Medicare payment model, bundled payment for care improvement (BPCI) programs aim to reduce spending by creating incentives for providers to remove expendable costs.
Bundled payments are “episode-based,” relevant to specific conditions or treatments in which providers are expected to absorb service costs and...National News
The report issued Tuesday, September 11, estimates the cost of the legislation, "Save American Workers Act," at $25.9 billion if the federal government retroactively suspends four years worth of penalties (2015-2019) for the employer mandate and $18.6 billion if the employer mandate only applies to employees working 40 hours rather than...National News
The American Hospital Association (AHA), the Association of American Medical Colleges (AAMC), America's Essential Hospitals, 340B Health, Genesis Healthcare System, Kearny County Hospital and Rutland Regional Medical Center asked a federal court to order the Department of Health and Human Services (DHS) to make effective within 30 days...Arizona News
Awarded by the US Department of Health and Human Services, the funding will enhance efforts to recruit health providers to serve in rural and underserved areas through ADHS’ State Loan Repayment Program (SLRP).
According to the press release from ADHS, the new funding will facilitate improved access to care in communities that...Arizona News
A discussion with The Hertel Report Publisher Jim Hammond on the most important stories we covered the week ending September 6, 2018.
Click on the microphone below to listen to the conversation moderated by Veronica Graff, a contributor to The Hertel Report.
...Arizona Comings & Goings
Mark El-Tawil is now the chief financial officer (CFO) of BCBSAZ and will provide direction and accountability for all financial planning and management functions, as well as support the organization's strategy and goals.
El-Tawil joins BCBSAZ from P3 Health Group, where previously served as CFO. He also previously...Data Resources
Analysts are forecasting a stabilization in premium prices for consumers shopping through Affordable Care Act (ACA) exchanges come fall open enrollment.
Based on preliminary state filings for ACA-compliant health plans, ACASignups.net released a table of projected increases for 2019 premiums. Run by analyst Charles Gabe, the site...Arizona News
Oral arguments were presented to a Texas judge Wednesday in a case centered on the constitutionality of the ACA's individual mandate brought by Texas and 19 other GOP-led states, including Arizona. The Department of Justice (DOJ) won't defend the ACA but also argues that the entire law should not be dismantled right away. Even if not...Arizona News
Two nonprofits, Intermountain Centers for Human Development and Community Partners Inc., that provide behavioral health care for AHCCCS beneficiaries, consolidated to weather the storm of forecasted payment cuts and changes to Arizona's Medicaid program.
The consolidation took effect on Friday, Aug. 31, 2018 as...National News
The healthcare industry has targeted mobile health as a means to increase care coordination and patient engagement as well as continue the pursuit to lower hospital readmission rates and costly emergency room visits. Mobile health apps present a cost effective approach to medical information as providers shift their patient perspective...
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The Hertel Report
