NEW YORK (Reuters)—Nearly a third of U.S. counties will likely be served by only one insurer that participates in an Affordable Care Act (ACA) marketplace in 2017, according to an analysis published Aug. 28 by the Kaiser Family Foundation. The 31% of U.S. counties that will have just a single option of insurers within the…
New York City Hospitals Settle Medicaid Repayment after Fraud Charges
NEW YORK (Reuters)—Three hospitals in New York’s Mount Sinai Health System will pay $2.95 million to settle Medicaid fraud charges for taking two years to repay more than $844,000 of improper billings that had been flagged by a whistleblower, authorities say on Wednesday. The accord resolves claims that Mount Sinai Beth Israel, Mount Sinai St….
Aetna CEO Warned It Would Cut Obamacare If Humana Deal Was Blocked
NEW YORK (Reuters)—Aetna Inc.’s CEO said in a letter to the U.S. Department of Justice (DOJ) during the review of its deal to buy rival Humana Inc that the insurer would exit much of the individual Obamacare insurance market if the agency challenged the merger. In the July 5 letter, Chief Executive Officer Mark Bertolini…
Prior Authorization Reform Achieves Some Success
In early August, the American Medical Association (AMA) held its annual state advocacy strategy meeting in Chicago. This meeting pulls together all state medical societies and national specialty organizations. Over three days, participants engage in roundtable discussions on issues, solutions and best practices for health policy. Networking opportunities abound. The meetings showcase legislation that has…
HIPAA Audit Activities Increase in 2016
In the coming months, rheumatologists may want to pay particular attention to their email inboxes. By the end of the year, the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) will complete stage I, phase II of a series of desk and on-site audits designed to assess providers and their business…
End of the Road: ICD-10 Grace Period Expires in October
The final milestone on the road to implementing ICD-10 (International Classification of Diseases, 10th revision) is drawing near. The 12-month grace period is scheduled to end as of Oct. 1, 2016, but that date will most likely pass with little notice, because implementation appears to have gone well since Oct. 1, 2015. “On average, it…
Aetna Pulls Back on Obamacare Health Insurance Plans in 2017
NEW YORK (Reuters)—Aetna Inc., the No. 3 U.S. health insurer, on Monday said that due to persistent financial losses on Obamacare plans, it will sell individual insurance on the government-run online marketplaces in only four states next year, down from the current 15 states. Aetna’s decision follows similar moves from UnitedHealth Group Inc. and Humana…
Importance of Oral Health, Mouth-Body Connection to Rheumatic Diseases Highlighted
Look inside the oral cavity of a patient for answers that go beyond what we perceive as the dentist’s domain. So goes the thinking of medical professionals interested in how oral health and bacteria-driven disease, such as periodontitis, may be linked to rheumatic disease, especially rheumatoid arthritis (RA). Bad bacteria that live in the mouth…
2016 ACR/ARHP Pre-Meeting Educational Workshops to Cover MACRA, Merit-Based Incentive and Alternative Payment Models
Looking for a reason to attend the 2016 ACR/ARHP Annual Meeting, which will be held Nov. 11–16 in Washington, D.C.? This monumental meeting will offer a variety of sessions on MACRA/MIPS/APMs, Medicare Value-Based Payment Reform programs, auditing, compliance and coding. Particularly, the pre-meeting workshops will provide you with the unique opportunity to dive deep into…
Rheumatology Research Foundation Helps Train Tomorrow’s Top Doctors
A passion to improve the clinical reasoning skills of future doctors led Maria Dall’Era, MD, associate professor of medicine and director of the University of California San Francisco (UCSF) Lupus Clinic, to create a revolutionary application for smartphones and tablets that could modernize medical education. With funding from the Rheumatology Research Foundation’s Clinician Scholar Educator…
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