Monthly Archives: July 2016

Oscar Health is Running into Some Headwinds

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.

What’s Next for the Anthem-Cigna Merger?

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.

 

Inaccurate Provider Data Adversely Impacts Members

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.

What is the Correct Coding for Zika Virus-Related Medical Conditions?

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.”