From Health Plan Week - Cigna Corp. says it is going national with its proprietary private exchange on Sept. 1, becoming the latest major insurer to forge ahead in the increasingly crowded business of distributing insurance digitally. The carrier is making its move well after early adopters have opted to open their own marketplaces, like Bloom Health Corp. five years ago (HPW 7/18/11, p. 5), but sees the timing appropriate for its market goals in the 51-employee and over space. Read more
From Health Plan Week - Back in 2011, when the medical loss ratio (MLR) rules went into effect, many market consultants said health insurers had a “perverse” disincentive to manage medical costs because of the structure of the MLR provision, which requires insurers to pay rebates to consumers if they spend too low a percentage of premiums on medical expenses. Read more
From Inside Health Insurance Exchanges - It’s been 10 months since state and federal insurance exchanges sputtered to life. While most of the major problems have been addressed — and 8 million people found coverage through the new marketplaces by the end of the enrollment period — industry observers aren’t confident the kinks have been permanently smoothed out. And a recent proposal to automatically re-enroll consumers who found coverage through HealthCare.gov could add another layer of… Read more
From Medicare Advantage News - CMS on July 16 took another step in the move toward the start of a long-delayed Recovery Audit Contractor (RAC) program for Medicare Advantage plans, as required under the 2010 Affordable Care Act. But the issuance by the agency’s Center for Program Integrity of a Statement of Work (SOW) for the MA RAC initiative still leaves attorneys with questions about how effective the program might be and what problems it… Read more
From Specialty Pharmacy News - Although the FDA has long taken a mainly hands-off policy toward laboratory developed tests (LDTs), that is about to change. Responding to growing calls to issue draft guidance — and ignoring other pleas to maintain the status quo — the agency notified Congress on July 31 that it intends to issue such guidance within 60 days. Read more
From Report on Medicare Compliance - Enforcement of the Stark law keeps taking new directions, and for the first time it veered into physician compensation inside a practice, unrelated to hospital referrals. New York Heart Center, a cardiology group practice with seven offices, agreed to pay $1.336 million to settle false claims allegations stemming from Stark violations, the U.S. Attorney’s Office for the Northern District of New York said Aug. 14. Read more
Check out all of the benefits, sample issues & more!