The CMS has started to answer the many questions surrounding how physicians will get paid under the Medicare Access and CHIP Reauthorization Act. But some stakeholders were immediately dissatisfied with what they saw, and the 963-page rule may have raised as many questions as it answered.
The skeptics were out in force last week when the CMS launched a major expansion of its comprehensive primary-care initiative. They are way off base.
Last fall, Karen Ignagni took over as CEO of EmblemHealth—a financially troubled New York insurer with 3.2 million covered lives—after 22 years at the helm of America's Health Insurance Plans. She recently discussed the challenges she faces in her new position.
Did the Obama administration indulge health insurance companies with friendly changes to Medicare Advantage rate policies for 2017? Or did CMS officials stick to their guns on proposals the industry aggressively lobbied to kill? Experts say it was a little of both.
The federal government has lowered average pay raises for 2017 Medicare Advantage plans, and it also modified several of the program's policies after weeks of unremitting lobbying from the health insurance industry.
The CMS is so invested in a demonstration meant to encourage use of clinically valuable services as a way to lower out-of-pocket costs for enrollees that it is asking for feedback on how to improve the program before it even launches.
This month, longtime Sentara Healthcare Chief Operating Officer Howard Kern took the reins from CEO David Bernd, who served 43 years at Sentara, including 21 as CEO. Editor Merrill Goozner spoke with Kern about the transition and the constant challenge of improving clinical quality.
Health insurers are spending more time and money on their Medicare Advantage products, yet the dominant players maintain an iron grip on the market.
The federal government is examining how it can beef up medical record auditing of Medicare Advantage insurers, which have been accused of exaggerating patient diagnoses to pad their payments. New procedures outlined by the feds will lead to heftier payment recoveries.
Widespread consumer dissatisfaction with the dominant carriers and the Affordable Care Act's new marketplaces for individual plans has led venture capital firms to take a chance on insurance startups.
Crystal Run Healthcare, a fast-growing, multispecialty physician practice in upstate New York, recently launched an insurance arm and has partnered with Mount Sinai in New York City to bring its patient-friendly focus into Manhattan. CEO Hal Teitelbaum discusses the group's strategy.
The CMS has scrapped a policy that lowered star ratings for Medicare Advantage plans facing sanctions for poor compliance. The move will immediately protect hundreds of millions of dollars at Cigna Corp.