New Accounting Rules To Help Political Subdivisions Health Care Costs

July 27th, 2015

gasb

New government accounting rules enable local officials to get unfunded obligations to retirees under control.

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When A Bad Surgeon Is The One You Want

July 27th, 2015

numbers

“Homo sapiens have always sought redemption. Today it is through data. Numbers have replaced Yahweh and Indra. But, just like the old gods were, numbers can be moody, arbitrary and, occasionally, downright unfair. Numbers are a human construct, after all.”

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K&K Launches Student Accident Coverage Website

July 26th, 2015

kkk

K&K Insurance Group, Inc., a subsidiary of Aon plc, has launched a new website at www.PrivateSchoolK12-kk.com offering K-12 student accident coverage. The website is designed for private, non-boarding K-12 schools and offers the ability to quote and purchase insurance online and receive coverage documents immediately via email.

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Anthem-Cigna Deal Creates Opportunity, Risk for Brokers

July 26th, 2015

streesed

Stressed Heath Insurance Broker Contemplates Future

“Brokers that are comfortable working on a fee-basis will be fine, but the majority of small and mid-size brokers still work on a commission basis, so this could be a real risk for them if they do not have the skill set or culture in their organization to engage clients on a fee-basis,” O’Connor says.

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Michael Turpin Nails It – Post Merger Market Place & Role of Brokers

July 26th, 2015

TURPIN “The only hope is more hospitals/health systems take-risk based contracts as accountable care organizations and fill the national void with myriad local fee standing health plans who can give the remaining national carriers a run for their money and keep competition alive.”

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The Affordable Consolidation Act Moves the Insurance Market From an Oligopoly to a Duopoly

July 26th, 2015

duopoly Only massive bureaucracies with huge compliance and legal departments are equipped to deal with the approximately 40,000 pages of the Patient Protection and Affordable Care Act’s laws and regulations.  It is crushing competition.

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Nevada School District to Settle Insurance Broker Suit for $1.65M

July 26th, 2015

clarkThe Clark County School District in Nevada says it will pay a former insurance broker $1.65 million to settle a lawsuit that claimed the public agency ended the broker’s contract prematurely.

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Greece’s Costly Health Care Craze

July 26th, 2015

envelope

Every stakeholder was benefiting from the system, except one: the patient. In addition to the official costs of care and drugs, there was another price people had to pay: a fee known as “the envelope.”

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Rio Grande Valley Medical Center Gains National Accreditation

July 24th, 2015

dhr1

EDINBURG – The Commission on Cancer of the American College of Surgeons granted three-year accreditation to the Doctors Hospital at Renaissance cancer program.

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Anthem-Cigna Deal Could Come Today

July 23rd, 2015

anthem

Report: Anthem-Cigna Deal Could Come Today

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The Case of The Missing Tooth

July 23rd, 2015

missingtooth

“The VA is funded with millions of dollars and billions of dollars but you will not pay providers? How is it the veteran’s fault that you are such an incompetent part of the United States government?” – Fred Rendon

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Assurant Self-Funded Business Sold To National General

July 21st, 2015

nationalgeneralNational General (rated A- by AM Best) has purchased Assurant’s block of self-funded business and will now provide marketing, actuary, and underwriting services.

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PPACA Exchange Plans Offer Less Choice of Doctors Than Commercial Plans

July 21st, 2015

kidding

Summary: The only way insurance companies can compete for business on the PPACA exchange is through lower rates. That is accomplished by paying providers less. Benefit design is mandated and therefore not a differentiator in plan selection.

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Sierra-Berkshire Associates Inc.

July 20th, 2015

riskassesmentSierra-Berkshire Associates, Inc. is a Nevada corporation, incorporated in February, 1996. The company’s main office is located in Reno, Nevada. Principal Associates are also located in Las Vegas, NV and in the Hartford, CT area.

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DHR Hopes To Double In Size – Competitors Whine

July 19th, 2015

whine

DHR hopes to double size, but faces opposition from other local hospitals

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Xerox, Eastman Kodak And Cost Plus Insurance

July 18th, 2015

trojan

Remember Xerox? How about Eastman Kodak? Both companies were pioneers in their industries. They were visionaries providing solutions by fulfilling previously unmet needs, creating new markets that did not exist before.

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Pros and Cons of Using Reference-based Pricing

July 17th, 2015

tellme

“Traditional models rely on a non-transparent contracting process in which insurance companies negotiate discounts off of over-inflated charges.”

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Brownsville ISD Seeks Health Insurance Proposals

July 16th, 2015

bisd

Brownsville Independent School District (BISD) is seeking proposals for administration of the district’s self-funded employee health plan. BISD is currently with Blue Cross.

http://www.bisd.us/Purchasing/html/Solicitations.htm

Blue Cross Private Exchange Announces New Enhancements

July 16th, 2015

hcsc

Chicago, IL, July 16, 2015 — Health Care Service Corporation (HCSC), the nation’s largest non-investor-owned health insurer, today announced several enhancements to its Blue Directions private exchange solution for large employers, available now for the upcoming 2016 benefit plan year.

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Children’s Hospital Of San Antonio Joins BCBS Network

July 14th, 2015

childrenhospBaylor College of Medicine, the academic partner for Children’s Hospital of San Antonio, has reached an agreement with Blue Cross and Blue Shield of Texas to participate in the insurer’s PPO plan.

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More Evidence Manage Care Doesn’t Work

July 14th, 2015

tissue1

Premiums are spiking around the country. Obama is in denial.

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Brownsville Doctor Fined $75,000

July 12th, 2015

tdiBrownsville doctor has an extensive disciplinary record with the Texas Medical Board, agency public records show.

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Are Health Care Networks Going To Jurassic Park?

July 10th, 2015

jurassic

Charging a fee for access to a group of health care providers has been a fantastic business. Low investment in capital assets, minimal labor costs and bountiful cash flows attract our country’s smartest investors. With margins above 60 percent, it is no surprise the Goldman Sachs of the world own networks.”

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An Analysis of Popular Legal Arguments Against Price Transparency

July 10th, 2015

mfnIn health care provider-insurer contracts, three types of clauses inhibit price transparency: (1) non-disclosure agreements, or “gag clauses;” (2) anti-tiering/anti-steering clauses; and (3) most favored nation clauses.

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Anthem, Cigna Progressing Toward Deal: CNBC

July 10th, 2015

ego

(Reuters) – Health insurers Anthem Inc (ANTM.N) and Cigna Corp (CI.N) were moving ahead to sign a merger deal as Cigna backed down on its differences over governance issues, CNBC tweeted, citing sources. TRANSLATION: Ego’s at play in the boardroom

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Study Shows Free Stuff Costs Less

July 8th, 2015

freestuffNew York Times reports that out-of-pocket spending on “most major birth control methods fell sharply in the months after the Affordable Care Act began requiring insurance plans to cover contraception at no cost…………….

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New Opportunity For Insurance Agents?

July 7th, 2015

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Phia Group – Claim Negotiation & Sign Off – Case Study

July 7th, 2015

PHIA

“The provider, as is the case with many, initially told us that it was not interested in negotiating at all….”

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The Employer-Led Health Care Revolution

July 7th, 2015

americanrevolution

Intel was rigorously managing its equipment suppliers but not its health care suppliers…….Intel decided it  could use its purchasing power in markets where it had operations to influence health care players—care providers, health plan administrators or insurers, and other employers—to rise above their competing self-interests and work together to redesign the local health care system….

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Assuring Hospital Emergency Care Without Crippling Competition

July 7th, 2015

emergencyroom

“Emergency departments are often more profitable than hospitals admit, as they are the source for roughly half of inpatient admissions. Patients admitted in emergency situations are rarely price-conscious, and revenue from ED admissions is often counted as part of subsequent inpatient stays. Furthermore, as non-urgent cases presenting in the ED are often relatively cheap to treat and well-covered by ED reimbursement rates, hospitals lack the incentive to redirect them to cheaper sites of service.”

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Appropriate Use Of Reference Pricing Can Increase Value

July 7th, 2015

reference“The U.S. Department of Health and Human Services has interpreted reference pricing as consistent with the principles of the Affordable Care Act when implemented by large, self-insured employers, and has adopted a salutary wait-and-see stance.”

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Insurance Companies Blame Actuarys

July 5th, 2015

odds1

Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected.

Upon hearing the news, hordes of actuarys flock to liquor stores throughout the fruited plane seeking solace……………..“An actuary is a person who passes as an expert on the basis of a prolific ability to produce an infinite variety of incomprehensible figures calculated with micro-metric precision from the vaguest of assumptions based on debatable evidence drawn from inclusive data derived by persons of questionable reliability for the sole purpose of confusing an already hopelessly befuddled group of persons who never read the statistics anyway.”    

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Anonymous Responds To BISD vs HealthSmart Settlement Terms

July 5th, 2015

gorilla1The perception that BISD was screwed by HealthSmart over so called provider “pricing discounts” demonstrates common ignorance. This is understandable since the general public has no understanding whatsoever how our health care delivery system is structured.

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Aetna To Buy Humana

July 3rd, 2015

price

Aetna buys Humana for $37B amid record number of health care deals

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High-Deductible Plans – Hospital Bad Debt & 75% Lower Utilization

July 1st, 2015

chasingdollarsHigh deductible plans are creating new headaches for hospitals, including more unpaid bills and seasonal demand for some healthcare services as patients wait to hit their deductibles before seeking non-urgent care.

The bulk of the savings through high deductible plans, up to 75%, come from lower utilization. It’s not the value of the increased deductible per se, it’s the change in behavior. When it’s other people’s money it doesn’t matter, but when it’s your money it’s a completely different dynamic.

Instead of jacking up prices, hospitals should work with local health plans to achieve equitable solutions – lower reimbursement rates for lower deductibles and co-insurance. Is 250% of Medicare and chasing dollars better than 100% of Medicare and not chasing dollars?

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4 Reasons Why Self-Funded Employers Should Choose A TPA Over An ASO

June 30th, 2015

dendy

Mike Dendy, President of AMPS (Advanced Medical Pricing Solutions)

By Mike Dendy

I have been in the healthcare business as a benefits consultant for 25 years.  10 of those years were spent as a TPA owner/manager with the last 10 as CEO of a cost management company reviewing the work of ASOs, TPAs, and PPOs.  I can say without reservation that employers with self funded (ERISA) healthcare plans should choose a quality TPA over an ASO carrier for the following four reasons.

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Beating Medical Trend – Managed Care vs Reference Based Pricing

June 29th, 2015

arrow

“Reference Based Pricing represents the last frontier in innovation to control health care costs in a tightly regulated and controlled market” – Bill Rusteberg

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The Chart That Could Undo The Healthcare System

June 28th, 2015

[The chart] outlines the growth of administrators in healthcare compared to physicians over the last forty years.  A picture is worth a thousand words, isn’t it?

You see, when you have that much administration, what you really have is a bunch of meetings. Lots of folks carrying their coffee from place to place. They are meeting about more policies, more protocols to satisfy government-created nonsense. But, this type of thing in healthcare isn’t fixing things. It’s not moving the needle.

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Brownsville ISD vs HealthSmart Settlement Terms Revealed

June 27th, 2015

mulebriar

HealthSmart to pay BISD $2 million in three payments………….

Local Brownsville blog reports on terms of Brownsville ISD vs HealthSmart settlement. The controversy concerned the promise of deep PPO discounts and the perceived notion on the behalf of BISD they were screwed. This is a classic example of suing a Ham Sandwich and winning through extortion. (type in Brownsville ISD in the search box on this blog for previous postings) – Molly Muebriar

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ScotusCare

June 25th, 2015

scotus

Scalia wrote that the justices who authored the majority displayed “no semblance of shame” in their opinion. His dissent is littered with jabs at his fellow justices. “Today’s interpretation is not merely unnatural; it is unheard of,” Scalia writes. He describes another aspect of the majority’s analysis to be “pure applesauce.”

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More Proof Managed Care Doesn’t Work – The Continued Failure of PPO’s

June 24th, 2015

cog

Milliman’s report is the latest indication that health-care costs, which saw a historic slowdown in their rate of inflation in the years after the Great Recession of 2008, are headed back up toward the trends seen before the financial meltdown

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The Answers is No – Your Management Sucks

June 23rd, 2015

suck

Why Cigna Rejected $47 Billion Bid by Anthem

June 22, 2015

Cigna Corp. rejected Anthem Inc.’s $47 billion takeover bid, saying it was inadequate, not in the best interests of shareholders and that Anthem’s management wasn’t fit to lead a merged insurance giant.

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Summer Session 2015

June 22nd, 2015

Designed for Public Purchasing Professionals with special emphasis on the latestdevelopments that are essential in general purchasing.  https://napmrgvpma.org/summer-session-2015/

List of Speakers    

Medicare Part G

June 22nd, 2015

plang

Say you are an older senior citizen and can no longer take care of yourself and the government says there is no Nursing Home care available for you. So, what do you do? You opt for Medicare Part G. 

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Drug Compounding Scam – Express Scripts Reacts

June 22nd, 2015

express  In one example recently highlighted by CBS Evening News, a compound pharmacy was able to successfully bill one of our competitors $44,707 for a one-month supply of compounded resveratrol, an antioxidant found in red grapes that can be purchased over the counter for $157.

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WellDyneRx Helps Polk County Save $1.9 Million On Rx Spend

June 21st, 2015

weldyneThe key to managing pharmacy benefits is having a good pharmacy benefit manager to ensure savings while maintaining the quality of the program.

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Democrats: “Underinsurance” To Be Campaign Issue for 2016

June 19th, 2015

moneytree

“We’ve got some 17 million more people covered … but they can’t access the care they seem to be entitled to,” McDermott said. “It costs too much to use the care. That’s the deceptive part about it.”

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San Benito ISD To Close On-Site Clinic – “Clinic Drives Higher Costs”

June 18th, 2015

really

The San Benito Independent School District board of trustees has decided to close their on-site medical clinic this year.

“The clinic is driving costs because of the way the referral system has worked” said the SBISD superintendent.

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Justice Department Strikes

June 18th, 2015
omg
“This action represents the largest criminal health care fraud takedown in the history of the Department of Justice”

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The Truth About Voluntary Benefits

June 18th, 2015

carsalesman

Marsh Consulting Group

Here’s a little-known secret: Voluntary benefits often provide the broker with a first-year commission exceeding 60%, compared to a 3-7% commission for health plans………….These products, which typically pay out less than 50% of the premiums toward actual claims, may in the end hurt employers’ creditability once their employees realize that voluntary benefits aren’t much of a benefit after all.”

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United Health Care To Purchase Aetna?

June 18th, 2015
seriously
“UnitedHealth Group Inc. has approached Aetna Inc. about a takeover deal that would likely be valued at more than $40 billion, … the latest move in a frenzy of merger talks in the health-insurance industry

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The Clock

June 15th, 2015

clockClick here

South Texas Health System Defends 920% Price Markup

June 15th, 2015

Rick Scott

What business do you know that marks up their prices by 920% and still stays in business?

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Selling ObamaCare – Gruberize The Process

June 14th, 2015

barak

“Michelle and I don’t want anyone telling us who our family’s doctor should be – and no one should decide that for you either. Under our proposals, if you like your doctor, you keep your doctor. If you like your current insurance, you keep that insurance. Period, end of story”. – Barack Obama

 

Corpus Christi ISD Hires New Health Insurance Consultant

June 12th, 2015

price

Corpus Christi Independent School District has awarded Gallagher a multi-year $200,000 per year contract for health insurance consulting services.  The previous consulting firm, Wortham, charged $85,000.

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TRS ActiveCare 2015-2016 Benefits & Rates Published

June 12th, 2015

http://www.trs.state.tx.us/active.jsp?page_id=/global/welcome_active

These 10 Hospitals Could Pick Your Pocket Clean

June 12th, 2015
pickpocket
What other business can inflate their costs by 100% and still stay in business?

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Food And The Cost of Health Care

June 12th, 2015

toyland

By Molly Mulebriar

We are all aware that health care costs continue to rise. We have fooled ourselves about why that is so. But what does this article have to do about food?

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Tenet To Buy Brownsville Doctors Hospital?

June 10th, 2015

bdhospital

Brownsville Doctor’s Hospital filed for bankruptcy on Dec. 11, 2013, and according to that filing, it had $8,093,632.54 in liabilities and $5,059,441.93 in assets.

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Tokio Marine To Buy HCC

June 10th, 2015

tokio

Tokio Marine Holdings of Japan said Wednesday that it has agreed to buy U.S. specialty insurer HCC Insurance Holdings Inc (HHC) for $7.5 billion, making the acquisition the largest by a Japanese company so far this year and the largest ever by a Japanese insurer.

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Will ObamaCare Cover Head Transplants?

June 10th, 2015

Animal testing: In 1970 Dr Robert White transplanted the head of one monkey onto the body of another, as shown in this diagram. If Spiridonov's head were to be successfully transplanted his jugular vein and spinal cords would have to be similarly fused with those of his new donor body

Will ObamaCare cover head transplants? If not, will Obama change his mind? Republicans hope so and have volunteered Ted Cruz as donor.

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Some Hospitals Charge 1000% Of Medicare Rates? That’s Outrageous!

June 9th, 2015

kidding

Some hospitals charge more than 10 times the Medicare rate, according to a new study published in Health Affairs on Monday.

“…..the mystery of the chargemaster continues. “What other industry can you think of that marks up the price of their product by 1,000% and remains in business?” said co-author Gerard Anderson.

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Small Company May Revolutionize U.S. Health Care Industry

June 8th, 2015

icucare

Company with 12 employees and $3.5 million in revenue has bid on contract that would earn more than $1 billion –  Poised to become the financial backbone of the U.S. health care system?
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Dave Belk, M.D.

June 8th, 2015
Here's my latest blog for HuffPost:
http://www.huffingtonpost.com/david-belk/the-skyrocketing-cost-of-_b_7492476.html

It addresses the skyrocketing prices of brand name prescription drugs.
Nearly every brand name medication has gone up in price over the last
couple of years; most have gone up more than 10 times the rate of
inflation.

Dave Belk MD

Preventing Low Volume Hospitals From Performing Certain Surgeries

June 8th, 2015

practice“If you’re only performing a hip replacement surgery three times a year, chances are you won’t do it as well as a surgeon who performs 200 a year. Practice makes perfect.”

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June 7th, 2015

RISKMANAGER

The shared vision of RiskManagers.us and clients who retain our services is to establish and maintain a comprehensive employee health and welfare plan, identify cost areas that may be improved without cost shifting to any significant degree, and ensure a superior and sustained partnership with a claim administrator responsive to members needs on a level consistent with prudent business practices.

Plan costs, in all areas including fixed expenses and claims are open for review on a continuing basis. Cost effective plan administration and equitable benefit payment to providers are paramount to fulfilling our mutual fiduciary duties. As we proactively monitor and manage an entire benefit program we are open to any suggestions members may make or the dynamic health benefit market may warrant in order to accomplish these goals.

Duty of loyalty to our clients, transparency and accountability are essential to the foundation of our services. To that end, we expect our clients to realize a substantial savings based upon the services that we will deliver.

 2014 RiskManagers.us All Rights Reserved

 Email: RiskManager@RiskManagers.us

DOL Audit Letter – Are You Prepared?

June 7th, 2015

ronreagan

Are you ready for your DOL audit? Maybe you should be since plan audits are on the rise – there are 17,000 new IRS agents out of training now, hungry to prove their worth. With quotas to reach and maintain, to advance up the lucrative federal government job corp ladder demands tangible results.

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Direct Provider Contracting Pays Off

June 4th, 2015

brooks

“The opportunity is that an employer group who is self-insured has the ability to create a flexible plan best suited for its employees,” Bud Brooks, President at Brooks Healthcare Solutions, says. 

Brooks says that it all boils down to avoiding the use of big, broad-based PPOs.

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Blue Shield Loses Tax Exempt Status – Others To Follow?

June 4th, 2015

bcbs“They act like a regular insurance company: big profits, generous salaries, and high rates.” That’s the conclusion Johnson came to as the state was auditing Blue Shield’s 76-year-old tax exemption.”

‘We’ve served our purpose and it’s time to disband and the assets can go back to the public.’”

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Dr. Bilhartz Rebuts Dr. Gawande

June 4th, 2015

titanic

“Alternative payment models are just another illusion for affordable care that has a different name. ACOs are merely one more bureaucratic experiment that shuffles chairs around on the deck of the Titanic, while the boat remains in fast pursuit of the iceberg.”

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ETMC Files $1 Million Suit – Wants To Be Included In PPO

June 3rd, 2015

 

etmc

The hospital says exclusion from the preferred provider networks (PPO) of these companies has created “serious and negative consumer impact.”

Note: Another good reason to leave the managed care world and pay medical caregivers a transparent, fair and reasonable reimbursement based off pre-determined benchmarkes.

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Data Shows Large Increases In Hospital Charge Master Rates

June 2nd, 2015

lustig Victor Lustig

http://www.nytimes.com/2015/06/02/business/medicare-payments-billing-hospitals-doctors.html?ref=business&_r=1

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Physician’s Group To Decide Telemedicine Policy As Insurers Expand Telehealth Coverage.

June 1st, 2015

 

telemedicine12

Forbes  (5/31) contributor Bruce Japsen wrote that the American Medical Association is set to debate and vote on telemedicine recommendations by the AMA’s Council on Ethical and Judicial Affairs “as the nation’s largest health insurers widen coverage of telehealth to unprecedented numbers of their health plan subscribers.”

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Insurance Agent Touts Cost Plus Insurance – Is School District Receiving Fair Value?

May 31st, 2015

domino

“By the time you add third party intermediary fees of $1 million and consider the additional balance billing liability to plan participants, Cost Plus Insurance may not make much sense to those in the domino parlor.”

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RiskManagers.us Website Visit Statistics

May 30th, 2015

visitor

Awstats provides statistics on traffic activity for this blog. Number of visitors per month from June 2014 to May 2015 has averaged 93,106  http://www.awstats.org/