Sweeping Medicaid rule targets enrollment boom in private plans

The CMS has released a sweeping proposed rule (PDF) intended to modernize the regulation of Medicaid managed-care plans. The Medicaid managed-care population is growing rapidly, but the last regulation governing such plans was issued in 2002.

In one provision that generated frustration among health insurers in the hours after the draft was posted, the CMS called for health plans to dedicate a minimum portion of the rates they receive toward medical services, a threshold known as a medical loss ratio.

As of 2015, plans doing business with Medicaid and the Children’s Health Insurance Program are the only health plans that aren’t subject to an MLR. The Obama administration is proposing an 85% threshold for Medicaid managed-care plans, the same as the government demands of large group plans in the private market.

America’s Health Insurance Plans, the largest trade group representing health insurers, quickly responded that applying an MLR to Medicaid managed care fails to reflect much of what the plans do to hold down costs.

“An arbitrary cap on health plans’ administrative costs could undermine many of the critical services—beyond medical care—that make a difference in improving health outcomes for beneficiaries, such as transportation to and from appointments, social services, and more,” interim […]

By |May 29th, 2015|Health Reform, Medicare/Medicaid|Comments Off

As billing complexity lingers, payment collection lags

Patients remain deeply confused over charges by providers and insurers, and the uncertainty is affecting collections, according to a recent survey.

Even as healthcare providers derive growing shares of their income from direct consumer payments—as opposed to payments from insurers—patients frequently are ignorant about their financial obligations, according to a recent InstaMed report that combined survey results of consumers, providers, and payers.

For instance, 63 percent of consumers said they did not know their payment responsibility during a provider visit.

That confusion echoed the poor financial understanding of many providers, 39 percent of which did not know the share of payment due from a patient during a visit.

Among the effects of such financial ignorance was the finding that 72 percent of providers report needing more than one month to collect from a consumer. And those outcomes led 58 percent of providers to identify consumer collections as their primary revenue cycle concern.

“The lack of clarity around pricing, around benefits, and around billing leads to difficulty in terms of collecting these dollars and impacts the revenue cycle,” Mark Rukavina, principal of Community Health Advisors, said in an interview about the survey report.
Challenges Identified
The report echoed other recent research identifying ongoing patient confusion regarding provider bills […]

By |May 29th, 2015|Health Reform|Comments Off

Healthcare Affordability Concerns Continue for Consumers

High premiums and unexpected medical bills that could cause debt are among the concerns for consumers who purchase their own insurance under the Affordable Care Act.

The affordability of coverage and healthcare continues to concern consumers who have insurance, according to a survey from the Kaiser Family Foundation. The survey is the second in a series exploring the experiences and perceptions of people who purchase their own health insurance.

While the results of the survey show high overall satisfaction levels with marketplace plans available through the Affordable Care Act, a significant minority of enrollees in nongroup plans report challenges and worries related to the affordability of coverage and care.

Making nongroup insurance affordable was a key goal of the Affordable Care Act’s changes to the individual market and its tax subsidies, according to a news release from the Kaiser Family Foundation on its survey results.

The survey is the second in a series exploring the experiences and perceptions of people who purchase their own health insurance, the group perhaps most affected by the Affordable Care Act’s reforms to the individual insurance market and tax subsidies to make such coverage more affordable, according to the news release.

The survey includes people in Affordable Care Act-compliant […]

By |May 28th, 2015|Health Reform|Comments Off


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