Insurance news
Doctors, Hospitals Say 'Show Me the Money' Before Treatment
Written by Editor   
Friday, December 16, 2016 12:00 AM

News Bite: With higher deductible insurance policies many in the healthcare industries are turning to prepayment.  Stats show that  while more than two-thirds of patients with a deductible of less than $1,000 were likely to pay at least some portion of what they owe, just 36 percent of those with deductibles of more than $5,000 did so.  Yet many patients feel “If I need medical care I should be able to get it without having to afford it up front."  Fifty-one percent of workers with insurance through their employer had a deductible of over $1,000 this year.

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Health Insurers' Exit Spells Trouble for Obamacare in Texas
Written by Editor   
Wednesday, September 07, 2016 07:13 AM

The roughly 1.3 million Texans who bought health insurance under the Affordable Care Act will likely have fewer, more expensive coverage options in 2017, as health plans continue to announce they will no longer sell their products in Texas.

Another Insurance company announced it would partially withdraw from the Texas market, joining veteran health plans Aetna, UnitedHealthcare and Scott and White on the list of companies that recently announced they would abandon the marketplace created by President Obama’s signature health law. The companies said their costs of providing coverage to middle-income Texans have been unsustainable, fueling concerns about a lack of competition and consumer choice within the health insurance market next year.

The announcements come at a time of uncertainty for health insurance markets nationwide, with several major health insurers opting to abandon the exchanges in all but a handful of states. 

I think what we should be expecting is premiums that are substantially higher, and I think there’s a real risk that other insurers pull out,” said Michael Morrisey, a professor at the Texas A&M University School of Public Health. “We may be beginning to see the death spiral of insurance plans in the exchanges.”

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Changes and Challenges with ICD-10 Coming Soon
Written by Editor   
Tuesday, September 06, 2016 03:50 PM

Last year’s ICD-10 transition went smoothly and with very few hiccups, but healthcare organizations do not have the luxury of resting on their laurels. October 1 marks the one-year anniversary of the code switchover, which brings new challenges they must overcome.

Organizations must now focus on three significant changes that will come into play starting Oct. 1, 2016:

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Insurer Cuts Doctor Pay, Will Others Follow?
Written by Editor   
Tuesday, April 05, 2016 12:00 AM

The move by insurer Highmark to reduce physician rates in health plans offered under the Affordable Care Act (ACA) to make up for massive losses has sparked anger, as well as worries that other insurers will follow suit.

Highmark, a Blue Cross and Blue Shield affiliate that operates in Pennsylvania, West Virginia, and Delaware, said it lost $221 million on its health plans in ACA marketplaces, or exchanges, in 2014, and that it expects to lose another $500 million in 2015 because enrollees have required more care than anticipated. That has caused the insurer to pay more in claims than it collected in premiums.

Last month, Highmark announced it would cut provider rates on average in Pennsylvania by 4.5%, effective April 1, to keep these plans viable, rather than shutting them down. 

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The Post-ICD-10 World
Written by Dr. Ray Foxworth   
Wednesday, January 20, 2016 12:00 AM

ICD-10 woes are an “insider issue” that your patients don’t want to hear about.


If you’re reading this, you made it past ICD-10’s transition date, and you’re still here to tell about it. Now that the implementation date is behind us, this is a good time to regain perspective and remember that even something as big as ICD-10 is only a part of your practice. Certainly it has nothing directly to do with your commitment to your patients or your relationship with them.

In other words, ICD-10 is an insider issue—one your patients should ideally never even hear about. So no matter how top-of-mind this transition may continue to be make sure the frustration, overwhelm, and distraction don’t make their way to your front desk or your exam table. Your patients don’t want to hear about your coding and financial department issues.

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