Payers Category

Aetna has apparently had enough of trying in vain to make participation in Affordable Care Act (ACA, or “Obamacare) exchanges profitable, and will exit all ACA exchanges for the 2018 coverage year. They follow a long line of insurers who already checked out, complaining that the ACA program simply made it impossible to conduct business, economically.  Aetna announced their plans right after revealing that they’d drastically reduce their exchange business for the 2017 coverage year, selling plans only in Delaware, Iowa, Nebraska, and Virginia this year. Aetna will become theRead More
Missourians who still haven’t gotten the message that the emergency room is the wrong place to be for a sore throat or other nonemergent complaints are in for a rude awakening if they’re covered by Anthem. Starting this summer, Anthem will stop paying a dime for visits to Missouri EDs if the patient is deemed to have a “minor ailment” (which, in addition to sore throat, includes, rash, mild fever, and ear or eye pain—anything that can be treated safely in a “less acute” setting). There are a few exceptionsRead More
Illinois is not unique in wrestling with Medicaid managed care plan problems, but the situation there seems to have reached a boiling point and can serve as a cautionary tale for urgent care stakeholders across the country. Health system officials there complain that getting providers approved by Medicaid managed care plans has taken anywhere from 6 months up to a whole year. Prior authorizations and reimbursements have been similarly slow in coming, making it so cumbersome to do business that some have quit dealing with the state Medicaid system altogether.Read More

Posted On April 12, 2017By JUCMIn Payers

Michigan Blues Start Pushing Telemedicine

Blue Cross Blue Shield (BCBS) of Michigan and Blue Care Network have apparently seen the light when it comes to the benefits of telemedicine. They’re working with physician groups on creating new financial incentives to expand member utilization. Seventeen groups, in fact, have already submitted telemedicine plans that could reap additional payments. Others are strategizing the best way to incorporate or expand telehealth offerings. BCBS says urgent care will figure prominently in its own efforts. Increased reimbursements and technology support are on the table for providers. Currently under the Blues’Read More
The Centers for Medicare & Medicaid Services is going to issue new Medicare cards, replacing beneficiaries’ Social Security numbers with unique ID numbers, by April 2019. However, the Health & Human Services Advisory Panel on Outreach and Educations says CMS isn’t doing enough to share more about the process with healthcare providers, who will have to make significant changes in their billing practices as the new ID card system is implemented gradually; CMS will start distributing the cards in April 2018, so it’s going to take a full year beforeRead More

Posted On March 8, 2017By JUCMIn Payers

Aetna–Humana Merger is Dead in the Water

Aetna Inc. and Humana Inc. have opted not to fight the decision a judge laid down to block their proposed merger based on the presumption that the $34 billion deal would violate antitrust laws. The two companies will continue to operate as separate entities, though the door is still open for either or both to seek other partners. Had the deal gone through, Aetna would have become a kingpin in Medicare Advantage. The implications for the health insurance industry—and, therefore, healthcare providers such as urgent care operators—are broader, and mayRead More
While previous attempts have crashed and burned, proposed new legislation could move California one step closer to a single-payer healthcare system. Proponents in the state senate say it is the “intent of the Legislature” to enact such a law “for the benefit of everyone in the state.” However, specific details and a prospective timetable have not been revealed. If it does pass and ultimately get signed into law, the measure would replace private insurance in California with a government plan that pays for coverage for the entire populace. The purportedRead More
Blue Cross Blue Shield of Georgia and Empire Blue Cross Blue Shield in New York are the latest insurers to require that urgent care centers become accredited before contracting, or as a requirement to maintain in-network status. As noted in a recent posting by Becker’s Hospital Review, such policies highlight growing demand for healthcare providers in all settings to demonstrate both value and quality care—both of which have long been touted as attributes of well-run urgent care centers. To attain accreditation, urgent care centers must meet nationally recognized criteria toRead More
Urgent care doctors, physician assistants, and nurse practitioners who did not demonstrate that they met requirements for meaningful use of electronic health record systems as mandated by the Centers for Medicare & Medicaid Services (CMS) will see a 3% decrease in Medicare payments starting January 1, 2017. As you read here, CMS first announced its plans to require clinicians to show meaningful use during a finite 90-day period that year. That finite period was later deemed inadequate so practitioners were allowed to file for hardship status that would allow themRead More
The Centers for Medicare and Medicaid Services (CMS) will ask Medicare beneficiaries how their healthcare providers are doing under the new Merit-based Incentive Payment System (MIPS), which was supposed to help improve the quality of care while lowering cost. No revelations are expected, however, because the survey is voluntary and CMS has taken a relaxed approach to getting providers on board with the new system. In addition, survey results—which, presumably, will be made public to help consumers make informed decisions—are going to be available only on the Physician Compare consumerRead More