CHS Sues MultiPlan Arguing Conspiracy With Health Plans To Fix Commercial Rates
Hospital giant Community Health Systems has filed a lawsuit arguing the data analytics firm MultiPlan has conspired with health plans to fix commercial rates in violation of antitrust rules. Visit my blog on the controversy: https://www.healthcarelabyrinth.com/out-of-network-provider-billing-is-yet-another-provider-attack-issue-against-plans/
(Article may require a subscription.)
#antitrust #healthplans #providers
https://www.modernhealthcare.com/legal/community-health-systems-chs-multiplan-lawsuit
Medicare-Medicaid Integration Could Have Pitfalls For Some MA Plans
Good article on the evolving mandates to force integration between Medicare and Medicaid. The Centers for Medicare and Medicaid Services (CMS) has passed several rules that will bring the programs together. Some Medicare Advantage (MA) plans do not look terribly well-placed to succeed, while others with big Medicaid membership do. Either way, it will be a huge transformation.
(Article may require a subscription.)
#snps #specialneedsplans #medicareadvantage
https://www.modernhealthcare.com/insurance/medicare-advantage-medicaid-dsnp-centene-molina
Medicare PA Bill To Be Reintroduced
A bipartisan bill that would levy more prior authorization reform and transparency will be re-introduced now that the Congressional Budget Office says the bill can be implemented at no cost. I will discuss what I think is a terrible bill in an upcoming blog.
(Article may require a subscription.)
#medicareadvantage #priorauthorization
Prominent Healthcare Leaders Come Out Against Trump
I don’t usually post articles that are purely political. In this case it is meant to say that healthcare issues do have traction whether or not they rank lower in voters’ priority lists. President Biden is wisely pursuing the issue.
#election2024 #healthcare
Illinois To Make GLP-1s Available For State Employees
While some states have reined in weight-loss drug availability, Illinois will expand GLP-1s for state employees at a cost of up to $210 million annually.
#weightlossdrugs #drugpricing
Medicare Advantage Under Pressure
A reasonably balanced article on the state of Medicare Advantage. It summarizes perceived pros and cons. It points to opponents’ charge of overpayments – 6% more per enrollee – and lower spending — up to 25% less on healthcare per enrollee. Again I doubt much of what opponents say. It also predicts a refinement of benefits due to economic pressures. Read my blog today on what I think are some coming reforms on risk adjustment: https://www.healthcarelabyrinth.com/will-cms-rein-in-risk-adjustment-submissions/
#medicareadvantage #riskadjustment #overpayments
Docs Want To Get Paid For Filing Prior Authorizations
While the concept is on hold, the American Medical Association could in time create a CPT code for providers to charge time for submitting prior authorizations. Oh, the irony.
#priorauthorizations
https://www.fiercehealthcare.com/payers/cpt-code-prior-authorization-heres-how-it-could-happen
— Marc S. Ryan
