All Articles In 'Health Plans'
Employer Sponsored Health Insurance: Changes in Health Premiums and Employee Contributions for Health Insurance
The Agency for Healthcare Research and Quality (AHRQ) has released interesting new data on increases in premiums and employee contributions for employer-sponsored health insurance coverage (ESI) from 2001 to 2009. Types of Employer-Sponsored Health Insurance Coverage: [...]
Medicare and Medicaid Compliance: OIG Advice for Operating an Effective Compliance Program
Comprehensive compliance programs are essential for all hospitals, health systems, physician practices, Medicare Advantage plans, Medicaid health plans, Medicare prescription drug plans, drug manufacturers, medical device makers, long-term care providers, and others doing business with Medicare, Medicaid, or [...]
Accountable Care Organizations: Your Guide to Strategy, Design, and Implementation, by Marc Bard and Mike Nugent
Are you ready to be an Accountable Care Organization (ACO)? Significant new opportunities and challenges face health systems, hospitals, and physician practices as they decide whether to participate in the new Medicare Shared Savings Program and join together to [...]
Compliance Challenges of Health Reform: Questions Compliance Professionals Should Ask as They Prepare for Health Care Reform
With an array of payment reforms, quality and safety requirements, massive expansion of Medicaid, and creation of the new State Health Benefit Exchange marketplace, the Affordable Care Act (ACA) presents extraordinary new challenges for compliance, especially [...]
Hospital Readmissions: Data on Hospital Readmission Rates for Medicare, Medicaid, Privately Insured, and Uninsured Patients
Hospital readmission rates are receiving increasing attention by Medicare, Medicaid, and private health plans. Research shows that a high proportion of hospital readmissions are preventable. Most hospital payment methods, most notably the Medicare Part A inpatient [...]
Direct-to-Consumer Advertising of Prescription Drugs: Legal, Policy, Market, and Public Health Issues for Potential Bans on DTC Advertising of New Brand Drugs
Direct-to-Consumer (DTC) advertising of prescription drugs, especially new brand-named drugs, remains controversial. Some in Congress remain eager to prohibit advertising of brand-name prescription drugs to consumers in the first two years following a drug’s approval by [...]
Medicare and Medicaid Fraud: Voluntary Self-Disclosure of Potential Fraud by Hospitals, Physicians, and Other Providers
Medicare and Medicaid program integrity efforts – coupled with complex coding and claiming procedures, ever-increasing program requirements, new payment methods, and the growing market share of taxpayer-funded programs – present significant compliance challenges for health plans, hospitals, [...]
Preventive Services: Understanding Preventive Health Services Covered under the Affordable Care Act
Under the Affordable Care Act (ACA), most health plans are now required to provide preventive services to their enrollees without any co-payments or other cost sharing. Over time, this is expected to significantly improve prevention and [...]
Health Reform: CMS Waivers of Annual Dollar Limits on Health Insurance Benefits
While most of the major health reforms start in 2014, the Affordable Care Act (ACA) imposes several new requirements in 2011 on health plans and self-insured employers. To prevent either a large increase in premiums or [...]
Medicare Payment Policy: Primers on Medicare Provider and Health Plan Reimbursement
The federal Medicare program has an array of complex payment policies for health care providers, health plans, and prescription drug plans. Fortunately, the outstanding staff at the Medicare Payment Advisory Commission (MedPAC) offer a series of [...]
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