Taking Advantage of Pricing Transparency as Healthcare Becomes Increasingly Consumer-Centric

February Wise Healthcare Consumer Month February is recognized as National Wise Health Care Consumer Month, established by the American Institute for Preventive Medicine. By raising awareness and opening dialogue, the Institute intends to make a long-term impact on the way healthcare consumers take personal ownership of their care.    Healthcare Consumerism Healthcare consumerism is a growing … Continued

A Single-Payer System: California Legislators Vote Today

Today the California State Assembly will vote on a proposal – AB No. 1400 — to create a single-payer healthcare system. They system would be similar to Medicare: a fee-for-service model. It would eliminate premiums, copays and deductibles. It would provide broad coverage, including: inpatient and outpatient, emergency and non-emergency medical and health facility and … Continued

Preserving the Harvest…Leveraging HSAs

Join Jack Towarnicky, with Humaculture’s Steve Cyboran, Wes Rogers and Kelley Long on Thursday, February 17, from 12:00 to 12:30 CST as they present the second installment of the Hidden Opportunities, Strategic Compliance Series. They will reconfirm why “unexpected” bills does not always mean “surprise” bills and demonstrate why Health Savings Accounts (HSAs) are a … Continued

The No Surprises Act Does Not Eliminate All Surprises

Jack Towarnicky, member of aequum, recently presented as a guest speaker during Humaculture’s Hidden Opportunities, Strategic Compliance Series. This was the first of a five-part series of monthly webinars that offer guidance to plan sponsors and third-party claims administrators on how to strategically respond to the No Surprises Act (NSA) and Transparency in Coverage requirements. … Continued

What is the Qualifying Payment Amount and Why is it Important?

Part I of the Requirements Related to Surprise Billing require cost-sharing amounts for emergency services provided at nonparticipating emergency facilities or by nonparticipating providers or non-emergency services provided by nonparticipating providers at participating facilities to be based on the lesser of the billed charge or the Qualifying Payment Amount (QPA) where an All-Payer Model Agreement … Continued

The No Surprises Act: A Litigation Timeline

With the New Year approaching, you may be wondering will the No Surprises Act really go into effect on January 1st (at least the parts that have not already been delayed)? The answer for now is YES. But, with four lawsuits pending in three courts, this could change at a moment’s notice. Here is a … Continued

Will the Providers Prevail? Challenges to the No Surprises Act

And the lawsuits have started… The Texas Medical Association (TMA) was the first to challenge the No Surprises Act. On October 28, 2021, TMA filed a Complaint in the United States District Court for the Eastern District of Texas seeking to vacate certain provisions of Part I of the Requirements Related to Surprise Billing (Part … Continued

Some Things Don’t Change

A study entitled, “Trends in the Concentration and Distribution of Health Care Expenditures in the US, 2001-2018” published in the JAMA Network Open[1] examined healthcare spending by between 30,461 and 39,165 individuals over that period. The authors[2] “sought to answer the following questions: How is the concentration of health care spending changing in the US … Continued