April 10, 2024

Community Health Centers Suffering From Medicaid Disenrollment

A new study of patients at community health centers are reporting major Medicaid disenrollments, which impacts the level of care that can be provided to these individuals.  Community health centers largely serve those in low-income areas.

It also finds that about 75% of people who have lost Medicaid coverage are still disenrolled. Further, 32% have chronic conditions, 24% are children, 12% were adults older than 65 years of age and 12% had disabilities.

#medicaid redeterminations #primarycare


Provider Impacts Continue From Cyberattack

Physicians continue to see major impacts due to the Change Healthcare cyberattack. This comes from an American Medical Association (AMA) survey of more than 1,400 individuals.

Over 77% of those surveyed said they experienced service disruptions beginning Feb. 21 and still feel impacts. Over a third (36%) saw claims payments suspended and 32% have not been able to submit claims. About 22% were not able to verify patients’ eligibility for benefits.  About 39% said they could not receive electronic remittance advice.

The impact is real.  United HealthGroup, Change’s parent, has made about $4.7B in assistance.

#changehealthcare #cyberattacks


HHS Secretary Becerra May Run For CA Governor

Articles are indicating that Health and Human Services Secretary Xavier Becerra may exit from his healthcare post at the federal level to run for California Governor.
Additional article: https://www.fiercehealthcare.com/payers/report-hhs-secretary-xavier-becerra-could-leave-bidens-cabinet-ca-governor-run

#hhs #becerra


AHA Wants Investigation of MultiPlan and Insurers

After a scathing New York Times article on the use of analytics vendor MultiPlan by major insurers, the American Hospital Association (AHA) wants the Labor Department to investigate, charging violations of law and engaging in business practices that disadvantage patients and providers. The Times article painted a picture of insurers limiting payments to out-of-network providers and transferring huge bills to patients.

(Article may require a subscription.)

#nsa #nosurprisesact #surprisebilling


Predictions That More Hospitals Will Term MA Plans

A financial analyst predicts that more hospitals and health systems will term Medicare Advantage (MA) plans and take just traditional program enrollees. Hospitals say that MA plans have much lower admissions and create cash flow issues by delaying or denying payment retroactively for visits that did occur. At least some of this issue could subside with the new prior authorization limitations passed in a recent rule.

#medicareadvantage #priorauthorization #hospitals


KFF Analysis Shows Lack of Data In MA Program

While I believe that Medicare Advantage (MA) is heavily scrutinized, regulated and accountable, the Kaiser Family Foundation (KFF) has put together an analysis of the so-called data holes in MA – things not reported to the Centers for Medicare and Medicaid Services (CMS) or not made public.  It is a thorough analysis and something MA plans need to read.  Many of these could be further mandates in the future.  To some degree, I think more reporting would help.  At the same time, I am not sure any reporting will ultimately satisfy provider critics, who want to destroy MA and move everyone back to the unfettered and unaccountable traditional fee-for-service (FFS) system.

#medicareadvantage #medicare #kff


— Marc S. Ryan

Leave a Reply

Your email address will not be published. Required fields are marked *

Available Now