AIS's Health Business Daily
Strategic Business News from Experienced Health Care Reporters
at Atlantic Information Services, Inc.
NOTE: AIS's Health Business Daily will not be published Sept. 1. The next issue will be sent on Tuesday, Sept. 2.

Health Plan Week
Today’s issue is brought to you by AIS's Health Plan Week, the industry's leading source of objective business, financial and regulatory news of the health insurance industry.

August 29, 2014

Today's Featured Story

Cigna Will Expand Its Private Exchange as Plan Strategies Play Out in New Markets
Reprinted 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 adapters have opted to open their own marketplaces, like Bloom Health Corp. five years ago, but sees the timing appropriate for its market goals in the 51-employee and over space.... Read Full Story

 

Quote of the Day

With Medicare auditors now authorized to rebuff professional fees “related” to hospital payment denials, “the interests of the hospital and the doctor become the same, so I think that’s a good thing. Instead of us chasing doctors down the street saying ‘please document better to help us,’ they will chase us down the street saying ‘please help us document better so we don’t lose money.’… I don’t know anyone who appeals hospital denials who thinks this is a bad thing for holding doctors accountable for poor documentation, which is why hospital claims are denied....[I]f they lose $10,000 or $20,000 a year on this denial business…they would really have a self-interest, which is the best interest to have.”

— Michael Salvatore, M.D., physician adviser at Beebe Healthcare in Lewes, Del., told AIS’s Report on Medicare Compliance.

Click here to read the RMC article in which this quote appeared. (Free for RMC subscribers; $17 for non-subscribers).

 

Today's Datapoint

$2.8 billion... was paid by Medicare Part D in 2012 for HIV drugs, and nearly 1,600 Part D beneficiaries had “questionable utilization patterns for HIV drugs,” according to new report from the HHS Office of Inspector General.

From DRUG BENEFIT NEWS.

 

Today from Washington

People on the Move

WIRB-Copernicus Group appointed David Borasky vice president of quality management for the Copernicus Group Independent Review Board. Prior to joining WCG, Borasky served as deputy director in the Office of Human Research Ethics at the University of North Carolina at Chapel Hill….MSC, a health care performance improvement company, promoted Mary Beth Loesch to president and CEO. Loesch joined MSC in 2013 as executive vice president of corporate development and health care.

 

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