Legislation pen nib pointing to the words in the dictionary, shot with very shallow depth of field,

Medicare and Medicaid could face dramatic change

Changes are around the corner now that a new president is at the helm, though it’s hard to sort out how the path to change or replace the Affordable Care Act (ACA)  will be effected. As of inauguration day, there were competing plans from Republicans, and few hints from the new president as to what he will actually propose. Thus far, he is saying his Health and Human Services (HHS) appointee must be confirmed before he’ll reveal details. That could happen in mid-February. Read more

Innovations in healthcare 2

Value-based care: burden or benefit?

With the uncertain future of the Affordable Care Act (ACA), it’s hard to know which features of the program, if any, will be preserved. Some features were designed to encourage what’s known as “value-based” care as a mechanism to drive down overall costs. The argument for value-based care is simply that physicians and organizations should be paid on the value of care delivered, rather than on the volume of services rendered. The commercial health insurance industry has been moving toward value-based care for some time, and Medicare has been testing alternative risk and compensation models of late under the ACA. Read more

doctor piggy bank

Is patient bad debt hurting your bottom line?

Healthcare providers are increasingly finding themselves acting as banks and bill collectors when it comes to getting paid for care. With the rise of high-deductible health plans and other cost-sharing, many patients are struggling to pay what their plans don’t cover. All too often, collection becomes the problem of clinical practices and hospitals. But there are ways to manage patient bad debt and prevent write-offs. Read more

Stock Photo illustrating American healthcare issues.

Looking into the unknown: a 2017 healthcare preview

With a major changeover in political leadership effective January 2017, a cloud of uncertainty hangs over the fate of healthcare, which represents a third of the United States economy. Undoubtedly, significant changes are on the horizon, affecting everyone from the consumer to the provider to the payer. It’s not surprising there is much angst regarding the unknown. Read more

Dec OE blog

Avoid patient coverage surprises after Open Enrollment

Open enrollment can create uncertainty and costly oversights for every healthcare provider. Premiums have already increased for the 2017 enrollment period, although major changes to the Affordable Care Act may take time to materialize. More immediate proposals for payment increases for skilled nursing facilities means the time to be aware of your options is right now. If you fail to detect a change in a patient’s coverage, the consequences can be severe, including delayed or even denied payments. When a patient changes health insurance and the new health plan denies reimbursement, you face an unpleasant choice: surprise the patient with a bill, or write off your services, costing you money. Read more

Congress Avenue street sign in AUstin Texas with an office building in the background.

What’s to become of the Affordable Care Act (ACA)?

With the recent election spurring a “repeal and replace” mantra for the Affordable Care Act, opinions and speculation now circle around how likely, desirable or even possible that may be. There’s simply no telling what’s going to happen, especially with key cabinet positions and transition plans for the new administration still in flux. Even among those opposing the ACA, there are significant differences of opinion. Read more

MENTAL HEALTH spelled in letters on a blue background.

President’s mental health parity task force weighs in


President Obama formed a task force among multiple government agencies last spring to address parity for mental health insurance coverage as it relates to coverage for medical/surgical care. Agency representatives heard from payers, consumers, providers, employers, advocates and others to further define parity and how it plays out in real life. The U.S. Department of Health and Human Services issued the report in late October. Read more

open enrollment illustration

Questions about ACA’s future don’t change current open enrollment needs

While the outcome of the presidential election has thrown the future of the Affordable Care Act into question, early predictions are that if replacement legislation is enacted, it won’t go into effect until two years from now. The upshot is that the annual process of open enrollment will continue for the time being on Healthcare.gov and state exchanges, just as it will for Medicare and employer-sponsored plans. Read more