Feb 15, 2021 | Physicians
Recent developments in chiropractic services include limited PFS changes, prior authorization policy changes, and managed care wellness models. Click to read more.
Feb 12, 2021 | Managed Care Friday
20%: The difference in reimbursement rates for ABA providers now that BCBS of Texas will begin tiering them for ABA therapy, effective April 2021. RBTs, Board Certified Assistant Behavior Analysts or clinicians with a bachelor’s degree will receive the existing rate, while clinicians with less than a bachelor’s degree and no RBT certification will receive 20% less. BCBAs and master’s level clinicians will receive an increase in rate of 20%. Gender Policy Winners: A new policy on gender surgery is likely a boost to mental health provider volume. Aetna is updating its commercial policies to...
Feb 11, 2021 | Legislation/ Budgets/ Macro
Congress enacted a budget resolution on February 5, allowing Democrats to move forward with economic relief, COVID-19 funding, and other priorities with only a simple majority in the Senate. Not all policy changes will survive the process of crafting a reconciliation bill. Click to read more.
Feb 9, 2021 | Legislation/ Budgets/ Macro
The BRG Healthcare Transactions and Strategy quarterly compliance bulletin compiles noteworthy developments in the healthcare sector related to compliance, program integrity, and enforcement activities. In the fourth quarter of 2020, we have taken particular note of: DOJ/HHS activity Two OIG reports Two Comparative Billing Reports Four GAO reports OCR activity Proposed and approved additions to the RAC audit list Click to read more.
Feb 5, 2021 | Managed Care Friday
20: Number of primary care centers Humana opens in four states this year, including Atlanta, New Orleans and Las Vegas. Leaning on Humana as your major Medicare payer for your primary care operation brings upside given the company’s investment in risk-based models and in some cases elevated PMPMs, but it also brings this evolving dynamic of competition from Humana’s Partners in Primary Care owned practice. Staff Boom Or Zoom? Two companies merged in January to become the biggest healthcare staffing firm in Washington state. The joint company, now known as Actriv Healthcare, will employ over...
Feb 2, 2021 | Legislation/ Budgets/ Macro
The Biden-Harris Administration faces a global health pandemic and a precarious economic situation. U.S. health policy topics will largely be overshadowed by Administration actions to address climate change, racial equity, and other deferred policy goals like immigration, leading to relative stability in healthcare and only incremental change. Click to read more.
Jan 29, 2021 | Managed Care Friday
29: Percent of primary care practices “hiring” mental health staff in 2021 according to our poll of 567 PCPs, pediatricians, internists and specialty doctors who manage conditions in which depression and anxiety are common, like asthma, crohn’s, cancer, pregnancy and rheumatoid arthritis. Landing Home: Landmark Health, which focuses on in-home medical care to frail populations, formed a value-based care partnership with Southwestern Health Resources, a clinically integrated network. Through this partnership, the pair will offer multidisciplinary medical care at patients’ homes for...
