Extension of Affordable Care Act Sign-Up Deadlines May Create Insurance Verification Uncertainty For Providers
Last week, the Centers for Medicare and Medicaid Services (“CMS”) issued an interim final rule which requires insurers to provide coverage effective January 1, 2014 through the health insurance exchanges to any individual who selects coverage through December 23, 2013. In the preamble to the interim final rule, CMS stated that “ an effective coverage […]
HORIZON DECISION
As everyone should be aware by now, Horizon has made the decision that it will not extend the policies it cancelled, even though both the President and the Commissioner of Insurance in New Jersey have authorized them to do so. It appears clear that the position of Horizon is that it has committed its resources, […]
Annual Fee On Insurers To Impact Small Businesses
As part of the Affordable Care Act, beginning in 2014, health insurance companies will be charged additional fees and costs, including a $63 per person tax on each person covered. Because the vast majority of large businesses (200 employees or more) are self-insured and do not use managed care plans, the Congressional Budget Office is […]
UNCERTAINTY CONTINUES
Attached is a Washington Post article and an Associated Press article which highlight, from the patient beneficiary point of view, one of the next big issues in the Affordable Care Act implementation. That issue is the narrowing of the provider networks which will significantly reduce the patient beneficiary’s choice of providers. This could result in […]
The ObamaCare Rollout Debacle Impact on Providers
While the media is focused on the impact on the patients/beneficiaries, the failures of the rollout have significant impact on the providers. One of the most significant impacts is the cancellation of numerous health insurance policies (so far approximately 800,000 in New Jersey) and a necessity for these individuals to have obtained new insurance policies […]
Issue of Future Reimbursement Follow-Up
Following up on Tuesday’s blog is a link to a Modern Healthcare article (which you may need a user name/password for) regarding the issue of tying “quality” to physician reimbursement. In addition, in light of the ObamaCare rollout fiasco, both the failure to have people enroll as well as the insurance cancellations, it appears that […]
Issue of Future Reimbursement
Attached is a link to the news release regarding Horizon’s announcement for ACOs and PCMHs. One of the most important parts of the article is the quote from Linda J. Schwimmer where she stated, “(This will only work) if the providers actually do manage patients well and have all the things that drive down cost.” […]
Physician Payment: The Issues Never End
In light of all of the issues facing the Congress—the budget, the debt ceiling, the sequester—an issue of substantial importance to providers is the automatic Medicare cut to fees paid to providers which will go into effect on January 1, 2014. The implementation of the Sustainable Growth Rate (SGR) will impact the ability of physician […]
Health Insurance Subsidies: An Issue that Bears Watching
As noted in an article in Reuters, the Federal District Court has refused to dismiss the litigation challenging the granting of subsidies on federal exchanges. This is important in New Jersey, since New Jersey is a federal exchange and not a state exchange. Assuming this litigation continues, and it is ultimately resolved on the merits, […]
Expansion of the Scope of Practice of Non-Physicians-a Harbinger of Things to Come?
Under the Affordable Care Act, there has been a constant discussion as to the lack of a sufficient number of health care professionals, particularly fully licensed physicians (M.D. or D.O.), to provide care to all of the individuals who will now have health insurance or who will be covered by the expanded Medicaid programs. To […]
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