Where we’re going

What results has the Trump Administration had with its opposition to the ACA? Two examples follow. In February 2018, 20 Republican state attorney generals and governors filed suit to have the ACA declared unconstitutional in the U.S. District Court for the Northern District of Texas in a case captioned, Texas, et al. v. United States … Continued

A recent decision from the U.S. Eighth Circuit Court of Appeals in Peterson v. UnitedHealth Group, Inc., et al., No. 17-1744 (8th Cir. 2019), and the lower court decision it affirms, place the practice of cross-plan offsetting squarely in the cross hairs of ERISA. Cross-plan offsetting is the recovery of alleged overpayments to a specific … Continued

“Few employers are using reference-based pricing (RBP) benefit design, even though there is broad awareness of its potential for delivering savings,” according to a qualitative study published in the February issue of The American Journal of Managed Care®. “Evaluations of US RBP programs have found reduced spending between 13.9% and 31.0% for joint replacement surgery, … Continued

Presently, Medicare pays only for emergency ground ambulance services when patients are transported to hospitals, critical access hospitals, skilled nursing facilities, and dialysis centers. Most Medicare beneficiaries are thus transported to one of these facilities even when a lower-acuity destination may be more appropriate. Based upon a White Paper by the U.S. Departments of Health … Continued