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3 Groups Payers Will Watch Closely in 2013

Jacqueline Fellows, for HealthLeaders Media, January 2, 2013

As health insurers look toward a year that will mark significant change in how they interact with consumers and the federal government, several issues over the Patient Protection and Affordable Care Act remain either unclear or unresolved from 2012.

Age ratings, medical loss ratios, and the sheer number of people looking for coverage, among other things, are still hurdles payers must overcome, though now the timeline to do so is even shorter because health insurance exchanges are due to come online in just 10 months.

There are many groups payers are watching to help make the 2013 healthcare landscape clearer not included on this list, but here are the top three groups whose actions will have the most impact on payers' decisions in the next 12 months.

1.Congress
The U.S. Senate and House waited until the last, the last possible moment before agreeing to avert the fiscal cliff. But its reluctance to forge a permanent solution brought in the New Year with a more of a whimper than of a bang for the healthcare industry.

The Sustainable Growth Rate (SGR) problem was sort of solved. To the relief of physicians, there will be no 26.5% cut to reimbursement rates, but the fix is still temporary. Medicare reimbursement rates for physicians will remain the same only through the end of this year.

The one-year fix will be paid for by other healthcare cuts that include reducing Medicaid Disproportionate Share Hospital (DSH) payments, reimbursement for ESRD patients, and for multiple therapy procedures performed on the same day.

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