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Kentucky Fried Health Plan
Cora Nucci, Senior Online Editor for HealthLeaders Media

To some, having a health plan means having no plans to get sick. To others, it means believing that someone else will take care of the bills. In a twist on the common tale of health insurance coverage being ripped away from those who need it, a state ruling puts a health plan where it isn't wanted.[Read More]
cora nucci
  September 1, 2010

 
Editor's Picks
HHS Kicks Off Early Retiree Reinsurance Program
Nearly 2,000 employers and unions have been approved to participate in a $5 billion early retiree reinsurance program created under the Affordable Care Act. The program, operated by The Department of Health and Human Services' Office of Consumer Information and Insurance Oversight, will help pay health benefit claims for early retirees—those individuals age 55 or older who are not yet eligible for Medicare. [Read More]
CMS Hears Provider Concerns Over 'Observation' Status
Officials at the Centers for Medicare & Medicaid Services are hearing mounting concerns from providers over a Medicare billing category for patients not sick enough to qualify for admission but too sick to be sent home. The problem is, after these beneficiaries are discharged, or if they are admitted to the hospital but for less than three consecutive days (the three-day rule), Medicare will not pay for subsequent care in a skilled nursing facility or for self-administered prescription drugs—some of which are extremely expensive. [Read More]
7 Tips for RAC Region D Providers
HealthDataInsights, the RAC for Region D, had the highest percentage of claims overturned on appeal, which shows that, like providers, HDI is not perfect. Diligent hospitals can improve their chances of success with the RAC process by following these expert tips. [Read More]
HealthSpring to Pay $545M for Bravo Health
Baltimore-based Bravo Health, Inc. is a privately held operator of Medicare Advantage plans in Pennsylvania, the Mid-Atlantic region, and Texas, and Medicare Part D stand-alone prescription drug plans in 43 states. HealthSpring already owns and operates Medicare Advantage plans in Alabama, Florida, Georgia, Illinois, Mississippi, Tennessee, and Texas and also has a national stand-alone Medicare prescription drug plan. Bravo Health's August 2010 plan payment reports reflected aggregate Medicare Advantage and PDP membership of over 100,000 and 290,000, respectively. For the first six months of 2010, Bravo Health generated premium revenue of approximately $832.8 million. [Read More]
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Managed Care Headlines
Consumers won reversals for 47% of health claim denials in New York
Insurance & Financial Advisor, August 31, 2010
California's safety-net health insurance premiums rise
The Los Angeles Times, September 1, 2010
Federal government throws up roadblock to Florida's Medicaid reform
The Florida Times-Union, August 30, 2010
Parkland hospital kept information from its auditors, feared federal subpoena on Medicare overcharges
The Dallas Morning News, August 30, 2010
Can concierge medicine for the few benefit the many?
The New York Times, August 27, 2010
Calif. approves average 14% Wellpoint rate hike
Reuters, August 26, 2010
 
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From HealthLeaders Magazine
Beyond Going Green

Expectations for environmental sustainability and stewardship are growing as healthcare leaders face heightened scrutiny from government and community. [Read More]
 
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Resources From HCPro

Learn how increased collaboration between providers and managed care payers has the potential to reduce costs, improve processes, and enhance patient care.
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Audio Feature
Preventing Missed Revenue Opportunities

Robert Sutton, partner at Chadds Ford, PA-based IMA Consulting, discusses tips for preventing missed revenue opportunities due to third-party payer contractual underpayment. [Sponsored by Emdeon] [Listen Now]
 
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