Affordable Care Act

CMS’s Fraud Prevention System Thwarts $820M in Payment Abuse

by Jacqueline DiChiara

A 10:1 return on taxpayer money is a rare feat. Nonetheless, an advanced state-of-the-art analytics system – the Fraud Prevention System – courtesy of The Centers of Medicare & Medicaid...

Risk-Value-Based Payment Programs a Return on Investment?

by Jacqueline DiChiara

Value-based payment readiness is apparently an area of weakness for senior financial executives, reports an executive survey from the Healthcare Financial Management Association (HFMA) and Humana. An...

Reconsidering ACA Limits, Fee-for-Value as Firm Payment Fix

by Jacqueline DiChiara

As the Affordable Care Act (ACA) continues to evolve, the healthcare industry thrives on crystal ball-esque predictions about what future challenges may arise. How will the Supreme Court’s King v....

Aetna Acquires Humana for $37B to Moderate Healthcare Costs

by Jacqueline DiChiara

Aetna has agreed to acquire its undersized competitor, Humana Inc, for $37 billion in cash and stock. The possible unifying together of two of the nation’s largest health insurers may generate an...

What is the Future of Healthcare Mergers and Acquisitions?

by Jacqueline DiChiara

As healthcare mergers and acquisitions reach a record high, will financial consequences follow? The roles of critical access hospitals (CAHs) continue to change as more are closing their doors due to...

CMS Announces HPID Final Rule Public Commentary Period

by Jacqueline DiChiara

The Department of Health and Human Services (HHS) released a Request for Information (RFI) earlier this month on the Health Plan Identifier (HPID). HPID – a standard identifier for health plans...

Increased Deductibles Create More Revenue Cycle Challenges

by Jacqueline DiChiara

The ability to collect payment from patients has changed dramatically with the recent proliferation of high deductible health plans (HDHPs). Increased deductibles mean more revenue cycle...

Subsidies Upheld, State-Run Exchanges Face Funding Issues

by Jacqueline DiChiara

The King v. Burwell ruling will likely be the last major hurdle the Affordable Care Act (ACA) faces from court challenges. Says Bill Melville, Market Analyst for Decision Resources Group, to...

‘Affordable’ Affordable Care Act as Sustainable Cost Model

by Jacqueline DiChiara

King v. Burwell's aftermath has been both praised as a “positive” and “disastrous” ruling as the dust continues to clear following last Thursday’s decision from the...

Burwell Addresses King v. Burwell: ‘Seize This Opportunity’

by Jacqueline DiChiara

The Affordable Care Act (ACA) is simply part of the fabric of America, says Sylvia M. Burwell, Secretary of the Department of Health and Human Services (HHS), during a White House press call mere hours...

Considering King v. Burwell’s Construction, Interpretation

by Jacqueline DiChiara

The aftermath of King v. Burwell is spreading like wildfire across the healthcare industry. Opinions and reactions circulate rather heavily this week – including thoughts from Sylvia M. Burwell,...

HHS Secretary Burwell Speaks on ACA, King v. Burwell

by Jacqueline DiChiara

Today’s King v. Burwell decision from the Supreme Court to uphold subsidies is a groundbreaking moment for the healthcare industry.  King v. Burwell examines whether or not those...

King v. Burwell Aftermath: Summary of Reactions and Responses

by Jacqueline DiChiara

Big healthcare news is finally here. Reactions to today’s landmark King v. Burwell decision from the Supreme Court are plentiful. Here is a summary of recently acquired statements from...

Supreme Court Upholds Subsidies in King v. Burwell Decision

by Jacqueline DiChiara

The Supreme Court has ruled on King v. Burwell, a stunningly significant healthcare lawsuit intended to formally unravel various foundational components of the Affordable Care Act (ACA). The...

How does the ACA Impact Providers’ Trust of Payers?

by Jacqueline DiChiara

How are those healthcare payers participating in Affordable Care Act (ACA) implementation performing? Perhaps pretty well, according to a tenth annual PayerView report card and ninth annual Payer Trust...

King v. Burwell Requires Addressing the Affordability Crisis

by Jacqueline DiChiara

The Supreme Court will soon rule on King v. Burwell, a momentous lawsuit intended to essentially reverse various pieces of the Affordable Care Act (ACA) with the possibility of subsidies for 6.4 million...

Is King v. Burwell a ‘Downward Death Spiral’ for Revenue?

by Jacqueline DiChiara

  King v. Burwell – a critical landmark lawsuit aimed to actively unravel core components of the Affordable Care Act (ACA) – is a heavily trending topic this week as the...

June 19: Week That Was in Healthcare Fraud and Malpractice

by Jacqueline DiChiara

Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice and the Office of Inspector General. The crimes reported...

CMS’s Internal Controls Neglect Payment Accuracy under ACA

by Jacqueline DiChiara

The internal controls that calculate and authorize financial assistance payments on behalf of the Centers for Medicare & Medicaid Services (CMS) are failing, says a report from...

Will Inefficient Financial Healthcare Reform Kill the ACA?

by Jacqueline DiChiara

Is the Affordable Care Act (ACA) hurling the healthcare industry further into the red? The answer is a definite yes, according to a recent RevCycleIntelligence.com article about key...