Jul 8, 2022 | Managed Care Friday
$100: The per member per day fine health plans will now face if they do not post the negotiated rates they pay to in-network providers and potential out-of-network billable amounts patients may owe, due to a new regulation that went into effect last Friday. Though hospitals have been slow to post their prices since that transparency rule went into effect, the much larger potential fines health plans face seems to be having the desired effect. Many large plans, including United Healthcare, have already posted the required information. But even full health plan compliance won’t automatically...
Jul 5, 2022 | Medicaid, Medicare, MedPAC
This brief summarizes recent activity at MedPAC and MACPAC including: MedPAC: Assessing payment adequacy and updating payments for hospital inpatient and outpatient services, physician/other health services, ASCs, and SNFs. MACPAC: Publishing June 2022 Report to Congress on Medicaid and CHIP, as well as reports reviewing policy levers related to SNF staffing levels and social determinants of health. Click to read more.
Jul 1, 2022 | Managed Care Friday
$12-36: The amount Optum claims their new lab benefit management solution can save health plans on a per member per year basis. Optum is launching a new program to combat unnecessary clinical testing, which can account for up to 30% of all tests ordered. Optum will work with Avalon to administer the solution. As Good As It Gets? Jack Nicholson’s character Melvin Udall in the 1997 movie put OCD on the map, showing moviegoers just how debilitating obsessive-compulsive disorder can be when ordering breakfast, navigating sideways, and trying to court the waitress. 25 years since the movie...
