Billing News Sep 2019



NBGH: Large Employers Have Serious Reservations About 'Medicare for All'

  • September 9, 2019

For the first time, the National Business Group on Health (NBGH) polled large employers about Medicare expansion plans, including a single-payer “Medicare-for-All” system, as part of its annual report examining their healthcare strategies.

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BCBS-Anthem: Reimbursement Policy Update: Frequency Editing-Professional

  • September 9, 2019

Frequency Editing policy applies frequency maximums per day and/or per date span within the same grouping which may be based on the CMS’s MUEs, industry standards, and/or code description.  Beginning with dates of service November 1, 2019, maximum units per day may be based on claims data analysis.

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Harvard Pilgrim Health Care and Tufts Health Plan to Merge

  • September 9, 2019

Harvard Pilgrim Health Care and Tufts Health Plan announced Wednesday plans to merge in an effort to "harness the combined strengths" of both organizations. The merger would combine two large, nonprofit Massachusetts-based health plans and would allow them to more effectively address growing cost concerns and expand product portfolios, officials...

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More Insurers Expected to Return to ACA Market Next Year

  • September 9, 2019

Despite ongoing political and legal battles over the Affordable Care Act, many health insurance providers are expected to enter or reenter ACA markets next year as a number of states take steps to stabilize their health insurance markets. The average number of insurers offering plans in ACA marketplaces increased to four this year, though...

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Technical Problem Results in Payment, RA Duplication from Anthem

  • September 9, 2019

Anthem recently experienced some technical problems that resulted in duplicate payments and provider remittance advice for BlueCard claims in error. The issue occurred for claims processed from July 22 to July 26.

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CA Surprise Medical Bill Law Lowers Hospital Reimbursement Rates

  • September 9, 2019

A case study shows a California law that sets out-of-network rates for surprise medical bills shifted bargaining power to payers and may have led to provider consolidation. Policymakers have recently prioritized addressing surprise medical bills, or large, unexpected physician bills for out-of-network care received at hospitals that are within...

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Humana CEO Broussard Urges Congress to Roll Back ACA's Maligned Health Insurance Tax

  • September 9, 2019

Bruce Broussard, Humana CEO, urged Congress to repeal HIF, which is maligned by the insurance industry, on the company's second-quarter earnings call. Eliminating the unpopular tax enjoys bipartisan support, Broussard said. Additionally, Humana is projecting that an additional 480,000 to 500,000 people will enroll in its Medicare Advantage plans...

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Allscripts Agrees to $145 Million HIPAA, Kickback Settlement

  • September 9, 2019

Allscripts Healthcare Solutions on Thursday announced it had reached a tentative settlement with the Justice Department to resolve investigations of a company the electronic health records vendor acquired last year.

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