MAGI and Insurance Exchange Strategies – Modified Adjusted Gross Income

In healthcare, the federal Patient Protection and Affordable Care Act (PPACA) introduces a new income definition—Modified Adjusted Gross Income (“MAGI”) for determining Medicaid income eligibility across the country. MAGI, pronounced the same way as the Biblical term, will be a regular figure in future accounts of who has access to the best prices for health care coverage and will be relevant for Insurance Exchanges ("HIX").

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Fiscal Cliff Debate, Mortgage Interest Deduction Compared to Cost of Medicare Fraud

When we consider what the U.S. Administration may hope to gain by curtailing the mortgage interest tax deduction, we should consider it in light of inefficiencies and fraud in healthcare that cost more. Bloated charges to Medicare cost HUNDREDS of BILLIONS to the U.S. government. In other words, the government is reimbursing some for services that were never provided to any taxpayer. This isn't a Red or Blue issue it is an American issue.

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State Insurance Exchange Status by Governor, Political Party – Introducing the HIX Index

As of Wednesday November 14th, here is an update on which direction each state is headed. States have until Friday November 16th to declare their intentions, although States received extra time from U.S. Health and Human Services to submit operating plans for the Insurance Exchanges until December, 2012.

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Out of Network Claims Market Gets More Interesting: Cedars-Sinai, UCLA Dropped by Anthem

Out of Network Claims Explained One of the most significant inefficiencies in health care is the pricing strategy of health plans regarding their policy on reimbursement for members who receive…

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ICD-10 Implementation Consulting Best Practices

One strategy is to continue to move ahead on ICD-10 process impacts, systems planning, and overall budgets but depending on readiness, get your consulting firm to help with both the requirements documentation and strategies for clinical documentation that don’t’ exist now. Why? The WEDI / NCHICA timeline suggests that health care providers should have started planning for ICD-10 about 18 months before the CMS announcement of a delay.

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ICD-10 date confirmed for October 1, 2014 – Move Ahead with ICD-10 Implementations

Finally, uncertainty about ICD-10 is lifted. "...rule changes the compliance date for the ICD-10-CM and ICD-10-PCS medical data code sets (hereinafter "code sets") from October 1, 2013 to October 1, 2014."

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Buffett Divests of Muni Bonds. What is Hospital Link?

What WSJ missed in their video recap: 15% of many muni-portfolios are NOT municipality related bonds. They are hospital revenue bonds. Buffet is the leader; average investors will now scrutinize this point and perhaps review what this means in hospital bonds and what reimbursement risks such as ICD-10 may be driving risk in the future.

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CAQH CORE Releases EFT and Remittance Advice Transactions, Public Comment Period Opens

CAQH CORE announced that the Centers for Medicare and Medicaid Services (CMS) issued an Interim Final Rule (IFR) with comment period – Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds Transfers (EFT) and Remittance Advice Transactions.

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