HealthAxis Blog

HealthAxis Group to exhibit at AHIP Institute

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HealthAxis Group to exhibit at AHIP Institute Location: Music City Center | Nashville, Tennessee Date: June 19, 2019 – June 21, 2019 HealthAxis Group is teaming up with our newest company, Analytics Partners at the AHIP Institute & Expo 2019. We are showcasing our comprehensive technology platform and services including: our core benefit administration system, web-based self-service portals, business process outsourcing services, and analytic solutions. Together, we are driving out inefficiencies in healthcare by providing alternatives to crippling legacy technologies and outdated ideologies. Join us at booth 719 and experience […]
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How Payers Could Assist Primary Care Docs with Value-Based Care

AHIP asks CMS to change Medicare Advantage payment formula

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The Centers for Medicare and Medicaid Services should update its county benchmark calculation in the 2019 final notice being published April 2. “America’s Health Insurance Plans is asking the Centers of Medicare and Medicaid Services to change the way the agency calculates Medicare Advantage payment rates, ahead of a final notice due out Monday. AHIP said it strongly believes CMS should update its benchmark calculation in the 2019 final notice. These reflect spending for enrollees with only Medicare Part A for care in hospitals and other facilities, enrollees with only […]
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The Next Obamacare Battleground: Subsidies For Out-Of-Pocket Costs

Reducing healthcare costs not one-size-fits-all, report finds

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A new Network for Regional Healthcare Improvement (NRHI) report that reviewed healthcare costs for five states found huge differences concerning costs and drivers. “The NRHI said bringing the higher than average cost states (Colorado and Minnesota) down to the average could potentially save more than $1 billion. The researchers added that the healthcare industry needs to address both price and utilization to make healthcare more affordable. There’s not a one-size-fits-all approach to reducing costs either. For instance, one region may have higher utilization. In that case, engaging physicians to consider […]
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Payers, Providers Pledge to Improve Prior Authorizations

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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 […]
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How Payers, Providers Could Streamline Medical Claims Management

All-Payer Claims Databases Offer Insights into Healthcare Spending

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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 […]
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CMS launches voluntary bundled payments model, first since spiking mandatory bundles

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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 […]
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Medical Device Data, UDIs on Claims Impact Costs, Patient Safety

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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 […]
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Does Blockchain Have A Place In Healthcare?

Quality Payment Program needs more technical assistance, oversight, OIG finds

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A new report by HHS’ Office of Inspector General gives CMS points for making significant efforts to implement the Quality Payment Program (QPP) but says challenges remain that could undermine the program’s success. “Without sufficient technical assistance, participating clinicians could struggle to succeed, while others may opt out of the program altogether, the report warns. CMS also needs to develop a comprehensive program integrity plan to guard against fraud and improper payments, according to OIG. In terms of implementing QPP, CMS has focused heavily on clinician readiness and acceptance of the […]
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CMS says it will change direction of CMMI

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CMMI’s new direction is to promote patient-centered care and test market-driven reforms “CMS innovation center programs in limbo as officials say free market approach will encourage competition among healthcare providers.The Centers for Medicare and Medicaid Services is redesigning its Innovation Center to give providers greater flexibility in payment models while encouraging greater competition among healthcare systems to drive down cost. The Innovation Center came out of the Affordable Care Act and introduced many new models shifting payment from fee-for-service to value-based care. But CMS is now looking for feedback on what […]
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Clampdown on network directories fueling online solutions

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HealthcareDive Feature “Providers are struggling to keep up with requests to verify network directory data as health plans comply with increasing mandates. Concerned about widespread inaccuracies in network directories for health plans, lawmakers across the country are seeking stricter data collection requirements. A mix of new state and federal regulations require payers to provide consumers with up-to-date network directories of available healthcare professionals.” Read the full article. Check out this article and more on social media!    
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