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June 28, 2011

Today’s issue is brought to you by AIS's Medicare Advantage News, biweekly news and analysis on the Medicare (and Medicaid) managed care programs.

Today's Featured Story

Don’t Expect RACs in MA Any Time Soon, CMS Official Says, Despite Mandate in Law
Reprinted from Medicare Advantage News

While the health reform law called for the extension of the controversial contingency-fee Medicare recovery audit contractors (RACs) to Medicare Advantage starting this past Jan. 1, don’t look for that to happen any time soon, a CMS program integrity official tells AIS .... Read Full Story


From the AIS Blogs

OIG Reviews After-Hours Codes in Light of Recent Settlements

Pediatricians that agree to see patients after their normal office hours and bill Medicaid might stop providing the service if prosecutors keep targeting them for alleged incorrect use of the codes, provider advocates say ... Read more


Quote of the Day

Health insurers “might not always get invited to the table, but you are the folks with the expertise. And because of that, I urge you to find ways to get invitations to offer your help [in building exchanges] … to give [states] the insight they need and to make sure that once activities are underway, you are partners at the table.”

— Candy Gallaher, AHIP's vice president of state policy, at the trade organization's recent Exchange Conference Series in San Francisco.

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


Today's Datapoint

$100 … can be earned by agents and brokers beginning this fall for every member they successfully enroll in a federally operated Pre-Existing Condition Insurance Plan.

Click here to read the HEALTH PLAN WEEK article in which this datapoint appeared. (Free for HPW subscribers; $17 for non-subscribers).


FierceHealthPayer News from our partner FierceMarkets

Episode-based payments have 'huge' savings potential, UnitedHealthcare exec says

Episode-based payments are leading to cost savings while boosting care quality, execs from UnitedHealthcare and Horizon Blue Cross Blue Shield of New Jersey unequivocally shared during a session at the AHIP Institute conference last week ... Read more


Today from Washington

People on the Move

Juan Jose Roman, vice president of finance and chief financial officer at Puerto Rico-based Blues plan operator Triple-S Management Corp., has accepted a position at a financial services company. He will remain at Triple-S until July 25….Blue Cross and Blue Shield of Minnesota named Zachary Meyer vice president of wellness and prevention. He was executive vice president and general manager at Ceridian Health & Productivity Solutions, a human resources outsourcing company.


Today's Featured Health Business Job Opening

Presbyterian Health Plan
Director, Provider Reimbursement
Albuquerque, N.M.

Place Your Ad Here

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