Oscar Health, the previous Wall Street darling that promised to revolutionize the health insurance industry, is facing some real issues as it faces the realities of doing business in the individual market and especially the ACA exchanges. The company that once had a valuation of $1.75 billion has posted losses of $92 million for NY State alone last year (where half of their members are) and slashed by 50% their provider network.
Read more here.
With the Feds suing last week to stop the Anthem-Cigna merger, its pure speculation as to what happens next. Anthem’s CEO has stated they will fight this in court w/a trial slated to begin in October. There is some interesting speculation as to how this will impact the payer landscape including the Aetna-Humana merger.
For those of us who have worked on systems implementation or migration projects, we’re done once we go live. We pack up our things and move onto the next assignment. Ever wonder what the real world implications of the project are once we go-live? From my many years on the payer side, a major pain point for health insurance companies is keeping their provider directory information up to date and accurate. And for those payers that have merged or integrated w/another payer (definitely more common than not these days), trying to merge, sort, and make sense of all this information can be quite a headache. In this article, here are some real life ramifications of inefficient or ineffective provider data management and how that is impacting members.
You’d have to be hiding under a rock (more like a boulder) to not have heard any news related to the Zika virus. If you’re like me and attract mosquitoes like crazy, this is definitely on the forefront of my mind. And for those of you who were involved in ICD-10 implementations, you might have wondered what the diagnosis code would be for Zika-related medical encounters. From this AAPC blog article:
“….if the Zika symptoms include a fever, the ICD-10 code would be A92.8 Other specified mosquito-borne viral fever (which includes “Zika (viral)” listed in the code description). For pregnant women who have contracted the virus, look to the code series 098 All maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium. If an infected newborns develops microcephaly, code Q02 Microcephaly.”
CMS has published a final rule that allows for the federal government to sell government-owned claims data to ‘qualified entities’ that are approved. This includes claims data for members in Medicare, Medicaid, and CHIP.
Read more here.
