Nonprofit health system Texas Health Resources has sued the Blue Cross Blue Shield Association (BCBSA) and its entities for entering into agreements to limit reimbursements to providers since 2008. The plaintiffs, in the 179-page lawsuit filed this week, allege horizontal market allocation and price-fixing by geographically restricting how many Blues plans do business in each region. Therefore, each plan benefits from a quid pro quo and “artificially reduced prices” paid to providers, the lawsuit reads.
Senior leaders at patient care organizations nationwide have been trying to prepare for what might come next in terms of healthcare policy, payment, and regulatory developments, after Congress passed a huge tax and immigration bill on July 3, and President Donald Trump signed it into law on July 4.
About 80% of emergency department visits of terminally ill nursing home residents are potentially avoidable, according to a study published July 7 in the Journal of the American Medical Directors Association. Researchers analyzed Interventions to Reduce Acute Care Transfers program data of more than 6,000 residents from 264 nursing homes across the U.S. to identify the specific medical conditions associated with potentially avoidable and unnecessary emergency department visits.
A new bipartisan bill would mandate that Medicare Advantage (MA) insurers "adequately reimburse" providers for services, citing a trend of health systems pulling out of MA contracts. The Prompt and Fair Pay Act was introduced by Reps. Lloyd Doggett, D-Texas, and Greg Murphy, R-N.C. The legislation would require that insurers pay providers at least what they would have received for services rendered under Medicare Part A and Part B.
Like us on Facebook
Follow us on Twitter
Follow us on LinkedIn