Bill Bunker

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American Medical Association Warns Government against Insurance Mergers

24 Sep 2015

A study by the AMA argues the proposed insurance mergers would significantly reduce competition in 154 metropolitan areas within 23 states. To recap, four of the five largest health insurers are proposing to join together in two mergers: 1) Anthem and Cigna, and 2) Aetna and Humana. If they go through, only three major insurers would remain, including UnitedHealth Group. The AMA is calling for these mergers to be blocked. AMA States Mergers Will Hurt Patients and Providers “A lack of competition in health insurer markets is not in the best interests of patients or physicians,” says AMA President Steven… Read More

Healthcare Costs are Less of Barrier for Patients in Need, CDC Reports

18 Sep 2015

A new report from the Centers for Disease Control and Prevention (CDC) National Center of Health Statistics (NCHS) found the rate of people who did not seek medical care because of cost fell to 4.4 percent, representing a 16-year-low. This rate has been on the decline since 2011, as the Affordable Care Act has steadily decreased the uninsured rate. The rate of people without health insurance stood at 9.2 percent for the first three months of 2015. In the same period just one year ago, the rate was at 11.5 percent. This is the first time since the 1990s that… Read More

Medicare Advantage Competition Dwindling Amidst Insurance Mergers

03 Sep 2015

A recent report from the Commonwealth Fund concluded there is little competition anywhere in the United States for private Medicare Advantage (MA) Plans. Researchers found that 97 percent of markets in the US counties were “highly concentrated” where a small number of insurers dominated. In rural markets, the competition is even worse. With recent insurance merger announcements, many experts are concerned the dwindling competition will hurt consumers. How Medicare Advantage Plans Work MA Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part… Read More

ACA Insurance Coverage Up, Uninsured Rate Down: What This Means for Practices

24 Aug 2015

The Centers of Medicare and Medicaid Services (CMS) recently released a new report that shows nearly one million Americans shopped for health insurance and picked a plan on the federally-run Affordable Care Act (ACA) exchanges since the regular sign-up season ended. The 2015 enrollment period concluded in February but consumers who experienced a qualifying major life event, such as getting married or having a baby, could still sign up after that. Other events include losing healthcare coverage or Medicaid eligibility. CMS officials state that 50 percent of the new plan selections were due to people losing existing plans. In addition,… Read More

What the Anthem-Cigna Merger May Mean for Physicians and Patients

30 Jul 2015

Anthem recently announced their intention to buy Cigna for $54.2 billion. Just a few weeks ago, Aetna moved to buy Humana for $37 billion. If these deals are approved, Anthem, Aetna, and UnitedHealthcare would be the largest insurers in the country. Why the move towards consolidation? For insurers, the price transparency brought on by the Affordable Care Act has weighed down profit margins. They view partnerships as an opportunity to save costs. Anthem estimates they could save $2 billion in annual costs if the merger is approved. Now the big question remains: Will the government approve the consolidation? “Economic evidence… Read More

Clarity Health Integrates with athenahealth EHR

21 Jul 2015

The Clarity Health team is happy to announce the availability of an integration with athenahealth to deliver completed insurance authorizations, helping our customers streamline referrals and accelerate patient care. You can read the full press release here. athenahealth adds to the list of EHR and HIT vendors Clarity has integrated with. By design, we created our platform to be vendor-agnostic to provide a complete insurance authorization and referral management solution. With the increasing move towards value-based care, Clarity is in a great position to automate referral processes in conjunction with other HIT platforms that customers have adopted. Medical practices currently spend 20… Read More

CMS Releases 2016 Medicare Physician Fee Schedule Proposed Rule

13 Jul 2015

The Centers of Medicare and Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) proposed rule on July 8th. Under the proposal, physicians will see a modest 0.5 percent payment increase on January 1st, 2016. CMS is accepting public comments on the proposed rule until September 8th. They will issue the final rule by November 1st. Despite the overall increase, specialties will be affected differently. Here’s a sample: Cardiology: The American College of Cardiology reports the proposed changes to be zero percent. However, this estimate could vary widely depending on the mix of cardiology services provided. Gastroenterology: Becker’s Healthcare… Read More

Top Five Free Tools for ICD-10 Transition

01 Jul 2015

The countdown to the ICD-10 transition on October 1st is ticking closer and physicians, practice staff, and healthcare IT vendors alike are gearing up for the big switch. The goals of the new ICD-10 implementation is to improve payment accuracy, reduce rejected claims, and improve disease monitoring and management. The transition period is anticipated to have a few bumps, as practices will be familiarizing themselves with a new and vastly larger code set. At Clarity Health, we recently launched ICD-10 codes alongside ICD-9 codes to help our customers transition at their own speed, as payer requirements may vary. To help prepare,… Read More

Clarity Health Processes One Millionth Referral

29 Jun 2015

We reached a huge milestone at Clarity last week – we processed our one millionth referral. This is a significant achievement for the Clarity team as we have worked hard to advance our technology, expertise, and processes to be the leading insurance authorization solution in the healthcare market. One of our early customers, Northwest Physician Networks, streamlined the referral and authorization processes across their organization resulting in great improvement for their organization. “We have seen the Clarity platform evolve into a comprehensive and highly reliable solution for the over 500 providers that make up our ACO community,” says Dr. Scott… Read More

Private Health Insurers to Increase Premiums for 2016

05 Jun 2015

The Centers for Medicare and Medicaid Services (CMS) released a new proposal of health insurer premium rate increases for 2016, ranging from 10 to 85 percent. These proposed increases affect the 37 states using Healthcare.gov as their exchange. CMS emphasized these proposed rates still have several months before they are finalized. Regulators in some states have the authority to overrule rate increases if they are determined to be too high. Some Insurers Worry What the Future Will Bring Many insurers say they are asking for higher premiums because they remain uncertain about how many people will be signing up for… Read More