HealthLeaders Media Health Plan Insider - November 3, 2010 | Health Insurers Win Some, Lose Some with MLR Rules View as a Webpage | Subscribe for Free
Health Insurers Win Some, Lose Some with MLR Rules
Jeff Elliott, HealthLeaders Media

The Department of Health and Human Services and the nation's health insurers are in the thick of what is turning out to be a lively battle over the finer points of Medical Loss Ratios. One key issue: Defining what constitutes a medical expense.[Read More]
cora nucci
  November 3, 2010

 
Editor's Picks
Suspicion of Medicare Fraud Triggers Most Reimbursement Suspensions
When providers who were overpaid $206 million in Medicare payments were suspended from further reimbursement in 2007 and 2008, the reason was suspicion of fraud rather than simple overpayment in nearly every case, according to a report from the Office of Inspector General. [Read More]
NCQA Releases Medicare, Medicaid Plan Rankings
The National Committee for Quality Assurance has published scorecards for 183 of about 300 Medicare plans, and 104 of about 200 Medicaid plans. Rankings were based on consumer experience, prevention coverage, and treatment. [Read More]
AHA: Observation Status Fears on the Rise
Hospitals are putting more patients into observation status for longer than 48 hours instead admitting them, in part out of fear of what happened at one California hospital this month, the American Hospital Association says. According to a CMS chart, in the four calendar years from 2006 to 2009, "observation" status claims climbed from 828,353 to 1.131 million. [Read More]
Intelligence Report: Patient Experience — Help Wanted
While 72% of senior healthcare leaders say that patient experience has been a priority in the past year, only 1 of 8 CEOs has primary responsibility for it. Our exclusive, original research and analysis examines this paradox and delves into the realm of patient experience and its challenges, including why healthcare leaders report lack of success in achieving the kind of patient experience they need to provide. [Read More]
HealthLeaders Media Rounds: Building Accountable Care Organizations
Hospitals and physicians are working hurriedly to build systems of care that reward quality, outcomes, and high-value care—the ingredients of the accountable care organization. Innovative healthcare leaders like Carilion Clinic and Norton Healthcare are getting ready now for the future of healthcare system delivery. Join us on Dec. 9 from Carilion Clinic and share the lessons these leaders have learned. [Register today]
Breakthroughs Report: Future Healthcare and Collaboration
Explore strategies to accelerate the drive toward more cost-efficient and quality healthcare. In this new HealthLeaders Media Breakthroughs report, leading hospital systems—Virtua, Crouse Hospital, Heartland Health, and The Chester County Hospital—share insights and lessons learned. [Register today]

Managed Care Headlines
CMS Under the Gun to Launch Physician Compare Site
HealthLeaders Media, October 28, 2010
HHS Early Retiree Reinsurance Program Growing
HealthLeaders Media, October 29, 2010
10% of CA Insured Opt for High-Deductible Health Plans
HealthLeaders Media, October 29, 2010
Medicare Cheat Used Homeless in Fraud Scheme
HealthLeaders Media, October 28, 2010
$10 billion Medicaid waiver approved for California
The Los Angeles Times, November 3, 2010
Humana's 3rd-quarter profit rises 30 pct
Bloomberg Businessweek, November 2, 2010
Physicians face painful decision on Medicare
The Washington Post, November 1, 2010
Former FL hospital executive indicted for Medicaid fraud
WCTV, November 1, 2010

Sponsored Headlines
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From HealthLeaders Magazine
Your Move:
Hospitals are Predicting, Adapting to Change


The business models that will emerge in the era of healthcare reform are still unclear, but leading hospitals and health systems are already positioning themselves to adapt when they do come into focus. They're taking the first steps toward becoming accountable care organizations even before anyone knows for sure what an ACO will look like—or even if they'll ever come to fruition. [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.
Discover how to integrate wellness into your DM programs.
Read about practical strategies for maximizing the effectiveness of health and disease management programs.
Learn how to educate and engage members.

Audio Feature
Payment Model Innovation: Sharing the Rewards of a Pay-For-Performance Program

Neal Peyser, Managing Director FTI Healthcare discusses the creation of payment incentives for better collaboration between hospitals and their medical staff. He describes how one facility was able to tap incentive payments from a commercial payer that were based on meeting quality and efficiency metrics, and share them with physicians. [Sponsored by FTI Healthcare] [Listen Now]
 
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