TelePayroll

Hospital Perspective Surprises Market

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Hip and knee replacements can improve quality of life and provide significant relief for those suffering with severe arthritic conditions. With Americans living longer than ever, total joint replacements represent one of the most commonly performed surgeries in the US, accounting for more than one million procedures annually.This number is expected...
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Coaching & Care Coordination for Chronic Care Management Works

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Patients with multiple chronic conditions have complex needs and are among the most challenging patients for a primary care practice to manage. One solution being adopted by practices to address this challenge is non-face-to-face care coordination—which entails motivating and coaching patients through a comprehensive plan of care covering physical,...
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TelePayroll

States May Be Required to Safeguard ACA Markets Without Federal Leadership

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Regulation of healthcare remains a complicated issue. States want things their way; insurers demand changes be made to help them provide affordable coverage; and the insured want something to happen that makes sense as soon as possible. While some claim proposed solutions would be a boon for small business, small business advocates and health-care ...
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Major Players Create New Committee to Make Healthcare Safer for Patients

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Some of the top healthcare groups—including government agencies like the Centers for Disease Control & Prevention and the Centers for Medicare & Medicaid Services—gathered in late May for the first time to examine new ways to make healthcare safer for patients. Led by the Institute for Healthcare Improvement (IHI), a newly launched steering...
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TelePayroll

Three ACA-Compliance Struggles Midsize Employers Face

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While some ACA rules have changed, the IRS forms relating to them may not yet reflect those changes. Many large employers learned from what they had done wrong in the past, but others still struggle. And many of the 51-employee companies that the federal government classifies as "large" are still having some trouble complying with ACA coverage and ...
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Meanwhile … the Number of Uninsured Americans is Rising

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At the end of last year's prolonged health care battle, many Americans breathed a sigh of relief. Some may have let down their guard too soon.But, the health care battle is far from over. It's shifted from major clashes in Washington, DC, heavily covered by the media, to more obscure battlefields: the states and the offices at the Health and Human ...
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Most ACOs Would Flee Medicare Program if Pushed to Take on More Risk

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A huge chunk of organizations says they would leave the Medicare Shared Savings Program if they're forced to take on financial risk, which could slow the system's transition to value-based care.  It’s also unclear whether the Centers for Medicare & Medicaid Services (CMS), which oversee the program, will make any new changes. A recent letter from the agency offered a vague response about a possible drop in participation, even as another agency indicated it is reviewing proposed changes to th...
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ACA Rate Change Season Upon Us

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State if VA Insurers Forecast Big Price Jumps – Other States In Same Fix Initial filings from several insurers aiming to participate on the state's ACA marketplace in 2019 show double-digit rate hikes. According to Documents Filed with Virginia Regulators: CareFirst Blue Cross Blue Shield is forecasting an average 26.6 percent boost that would affect about 8,400 enrollees. Company subsidiary Group Hospitalization and Medical Services filed rates seeking an average 64.3 percent rate increase for ...
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HHS Releases Plans - Deregulation With Focus on Financial Risk … Non-ACA Plans

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Providers, insurers and pharmacies can expect a major regulatory overhaul later this year.  The administration's spring 2018 unified agenda , released on Wednesday, offered a preview into various agencies' regulatory and deregulatory plans for the near future. Policy changes outlined by the Department of Health and Human Services (HHS) include reduced paperwork burdens for hospitals, greater flexibility for non-ACA-compliant plans, and additional tactics to fight the opioid epidemic, all of whic...
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Reimbursement, Quality Scores & Risk Adjustment Improve HCC Practices

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Hierarchical condition categories (HCCs) reveal the severity, complexity and interaction of member conditions. They are used by the Centers for Medicare and Medicaid Services (CMS) to adjust risk scores that determine payment for Medicare Advantage (MA) beneficiaries. With CMS leading the way, additional government and commercial payers leverage HCCs to drive quality ratings, shared savings, risk scores and payment adjustments for a broad range of value-based contracts and activities. As HCCs ri...
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