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Industry News

Apr 20, 2018

In Virginia, one pediatrician tweaked electronic health record billing codes so Medicaid and private insurers are paying for patients' trips to food banks.

In California, Colorado, Massachusetts and Vermont, variant comprehensive models of getting payers involved in setting standards for dealing with food insecurity are underway or already up and running.

But the mounting push to expand and hone how the medical community treats food insecurity is clashing with the fight over...

Apr 20, 2018

Historically, clinicians have steered clear of becoming certified to treat patients with substance abuse disorders or expanding that patient base because they don't get paid enough to do so or struggle with prior authorization to get reimbursed.

A new payment model recently introduced by two leading medical associations aims to increase the number of providers who treat opioid-addicted patients with medication-assisted therapies.

The American Medical Association and the...

Apr 20, 2018
A federal court allowed health insurers to sue together as a class in challenging the federal government's failure to pay cost-sharing reduction payments.

Judge Margaret Sweeny of the U.S. Court of Federal Claims granted Wisconsin-based Common Ground Healthcare Cooperative's request for class action status on Tuesday. She rejected the federal government's argument that the insurers shouldn't receive class action status because their alleged damages would vary, since some insurers were not...

Apr 20, 2018

These days, when the federal government turns in one direction, California veers in the other — and in the case of health care, it’s a sharp swerve.

In the nation’s most populous state, lawmakers and other policymakers seemingly are not content simply to resist Republican efforts to dismantle the Affordable Care Act. They are fighting to expand health coverage with a series of steps they hope will culminate in universal coverage for all Californians — regardless of immigration status...

Apr 19, 2018

Several provider groups on Thursday criticized a value-based payment program created by MACRA for potentially causing harm to patients and setting physicians up to fail, which could spark millions of dollars in financial penalties.

Members of the American College of Physicians found that just 37% of the 86 quality measures in the Merit-based Incentive Payment System would actually improve the standard of care a patient received.

The review, published Thursday in the New...

Apr 19, 2018

HHS wants to delay implementing several planned changes to federal policy that governs research on people and human biological specimens.

In January 2017, HHS finalized several changes to the so-called "Common Rule," which has been in place in its current form since 1991. Although the changes were supposed to kick in on July 19, HHS is now proposing to move the effective and compliance date to Jan. 21, 2019.

Last year's rule required researchers to work with a single...

Apr 19, 2018

The parent of Blue Cross & Blue Shield of Illinois, the state's largest insurer, made more than a billion dollars last year, rebounding after three years of Affordable Care Act-related duress.

Health Care Service Corp.'s 2017 net income soared more than 10-fold, to $1.26 billion, according to its newly filed financials. That marks a return to traditional levels and even tops the $1.01 billion reported in 2012, before the impact of the 2010 law, commonly called Obamacare, took...

Apr 19, 2018

The Food and Drug Administration appears to be taking a proactive and long-term approach toward improving medical-device safety.

On April 17, the FDA released its Medical Device Safety Action Plan, in which regulators set out their goals for improving device safety, including tracking a product's safety throughout its life-cycle and catalyzing innovation that will make devices safer.

"Overall, this is a positive step to try to take proactive action to create a better...

Apr 19, 2018

The Trump administration's proposal to allow insurers to sell short-term medical plans that last up to 12 months, coupled with the repeal of the Affordable Care Act's individual mandate penalty in 2019, is bound to drive up enrollment in the short-term plan market next year. Some insurance companies are gearing up to capitalize on what they hope will be a flood of new customers by adding new, attractive benefits to their short-term...

Apr 19, 2018

California Attorney General Xavier Becerra has ordered three California hospitals to pay out millions of dollars to local not-for-profits, declining their requests to be freed from charity obligations required under state law.

The hospitals, based in the Central Valley and Los Angeles, argued that there isn't as much need to support charity care because millions more people have health insurance under the Affordable Care Act, and therefore don't need as much financial help to pay...

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