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Month: February 2018

Payers, Providers Pledge to Improve Prior Authorizations

AHIP, BCBSA, AHA, and other organizations have agreed to improve the efficiency of prior authorizations.
“Leaders of organizations participating in the pledge claim that aligning goals to improve prior authorizations can reduce the challenges of payers, providers, and other healthcare organizations face when managing high-cost prescriptions and medical devices. “Prior authorization approvals can be burdensome for health care professionals, hospitals, health insurance providers, and patients because the processes vary and can be repetitive, AHIP said in a press release. Prior authorization requirements can be better targeted if they take into account provider performance measures, the organizations noted.” Read the full article.
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AI funding exceeds $1B in 2017

Report confirms what industry watchers have already been noticing: Artificial intelligence in healthcare is hot.
“The quality and reliability of the data feeding AI solutions is particularly crucial to AI’s ultimate value in healthcare, and that could be a problem given lack of clear data standards. Progress on interoperability has been slow, but CMS Administrator Seema Verma said in town hall webcast this week with American Hospital Association CEO and President Rick Pollack that the agency is interested in seeing movement on the issue.” Read the full article.
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CMS MBI Notification

Client Notification

Date:  February 15, 2018

Topic: MBI

Purpose: The following notification is to inform our Medicare Health Plan clients that HealthAxis Group is following CMS protocols and will be fully compliant with the project to receive & store the new MBI number that will be assigned to Medicare members.

CMS Social Security Number Removal Initiative (SSNRI)

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 mandates the removal of the Social Security Number (SSN)-based HICN from Medicare cards to address current risk of beneficiary medical identity theft. Therefore, the Centers for Medicare & Medicaid Services (CMS) is required to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new, unique Medicare Number will replace the SSN-based Health Insurance Claim Number (HICN) on each new Medicare card. Starting April 2018, CMS will begin mailing new Medicare cards to all people with Medicare on a flow basis by geographic location and other factors.

At this time, HealthAxis Group is following CMS protocols and will be in full compliance with this initiative. We expect internal QA testing to be complete by mid-March and UAT testing complete by the end of March 2018. You can find more information about this transition on the CMS website.

We encourage our current clients to reach out to their Account Manager if you have any additional questions.

About HealthAxis Group, LLC

Through its affiliated companies, HealthAxis Group provides outstanding information technology and service solutions that help payers and providers work more efficiently and collaborate to deliver better health with improved efficiency and lower costs. HealthAxis Group helps healthcare organizations address compliance; improve administrative efficiency; lower cost, and improve quality and delivery of care. Payer solutions include benefits administration platforms, web portals, network & application management, consulting, BPO, and transaction services. Provider offerings include practice management solutions, electronic medical records, and technology services that help providers operate more efficiently and effectively.

Media contacts: HealthAxis Group, info@healthaxis.com

All-Payer Claims Databases Offer Insights into Healthcare Spending

The data from an all-payer claims database can reduce wasteful healthcare spending by supporting population health and analytics-driven healthcare decision making.
“All-payer claims databases (APCDs) allow payers, providers, and regulators to analyze claims from millions of beneficiaries to learn where spending is directed and whether or not spending on certain healthcare services is avoidable. State-level all-payer claims databases can help stakeholders to manage population health and identify opportunities to reduce wasteful or preventable healthcare spending within the commercial and public insurance sectors. Sixteen states currently have APCDs in operation, while many more are considering developing regional systems that allow public access to data on provider charges, payments, diagnoses, and patient demographics.” Read the full article.
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FDA lays out digital health goals in 2018 strategic roadmap

Leveraging innovation and competition to better healthcare is one of the four cornerstones of the Food and Drug Administration’s 2018 policy roadmap
“The roadmap touches on several efforts to help develop medical devices, specifically the establishment of a Total Product Life Cycle Office within the Center for Devices and Radiological Health and the development of an alternative 510(k) pathway. FDA also plans to publish final guidance on what digital health technologies fall under FDA’s regulation and those that the agency plans to exercise enforcement discretion on. In December, the agency published a trio of documents that laid out its proposed thoughts on how it will approach its regulation of the space. The FDA chief acknowledged that modernizing how the agency regulates new areas such as digital health to ensure that the agency’s policies are suited to the new challenges. The plan pointed to enabling consumers to use new technologies, such as digital tools and medical apps, to make up-to-date decisions about their health.” Read the full article.
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CMS launches voluntary bundled payments model, first since spiking mandatory bundles

The agency’s Innovation Center said the new Bundled Payments for Care Improvement Advanced model is the first APM that would qualify under MACRA.
“The Centers for Medicare and Medicaid Innovation Center has launched a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced — which CMS Administrator Seema Verma said is the first Advanced APM. The current Bundled Payments for Care Improvement Initiative, or BPCI, is scheduled to end on Sept. 30. BPCI Advanced starts on Oct. 1 and runs through Dec. 31, 2023. The BPCI will qualify as an advanced alternative payment model under the quality payment program for MACRA. With advanced APMs, providers take financial risk, but can also reap an incentive payment reward.” Read the full article.
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Medical Device Data, UDIs on Claims Impact Costs, Patient Safety

According to recent reports, payers who incorporate medical device data and UDIs into their claims may improve costs and patient safety.
“Adding medical device data and unique device identifiers (UDIs) to insurance claims could have a significant positive impact on healthcare spending and patient safety, according to reports from Pew Charitable Trusts, Brigham and Womens Center of Surgery and Public Health, and OIG. However, most insurance providers, including Medicare, do not have the data collection methodologies in place to gather this valuable information, leaving providers, patients, and payers at risk for adverse outcomes.” Read the full article.
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