We've compiled health benefit news from sources relevant to claims managers and third-party administrators. From the latest updates on COVID-related initiatives to innovation in health care, we strive to provide interesting and relevant information for our customers.

Executive order on Prescription Drug Costs

The Trump administration is issuing an Executive Order to reduce the amount of money Medicare pays for prescriptions and the amount of money patients will be required to pay. Currently Medicare pays a premium for drugs and Medicare Part D rebates for drugs are given to pharmacy benefits managers would be required to be passed on to patients.

The order would also reduce costs for insulin and epinephrine through importation of drugs from other countries and by eliminating the practice of hospitals purchasing epinephrine at a lower cost and charging more to patients. Read more about this Executive Order.

(Source: Forbes.com)

Advisory Board Expert: Health Plans Seen Pushing Accountability for Individual Physician Performance

As value-based contracting increases, so will the risk in the short term. Providers are struggling now and plans may not want to add to their burden. According to an article in Healthcare Innovation, there may be an upswing in upside risk and plans may make advanced payment to providers to help support them but also to keep medical loss ratios stable.

Blue Cross and Blue Shield of North Carolina is an example of this. They have created Blue Premier that they hope will serve as a model for health care in the future. Blue Premier addresses three critical areas in health care—changing how the plans pay for care, “putting primary care first,” and having a “better integration of mental and behavioral health”. Read the full article.

(Source: Healthcare Innovation)

Captive Insurance Case Headed to the Supreme Court

The Supreme Court will hear an appeal from a 2019 case involving CIC, a Knoxville-based captive manager and the Internal Revenue Service (IRS) later this fall. All eyes are on this case as it will determine if micro-captives are considered “transactions of interest” that should be reported to the IRS. Micro-captives that are taxed under 831(b) of the IRS code want to be allowed to pay federal income tax only on their investment income. However, the IRS disagrees with this interpretation of the code and wants micro-captives to be considered transactions of interest to avoid companies using them for tax evasion. Read more.

(Source: Captive.com)

COVID-19 Is Changing the Workers’ Comp Playbook: Are You Giving Your Claims Team What They Need to Prepare?

Health care worker’s compensation, perhaps unsurprisingly, has been hard hit since the pandemic. Claims processing is changing day by day and it can be hard to keep up with new regulations as they can change rapidly. Those changes, in addition to the increased volume of cases has left many claims managers overwhelmed. Claims managers can be kept up to date with corporate communication, webinars, and conference calls. It’s important to consistently and constantly reinforce messaging.

Processing claims is what we do at Complete Health Systems. If you’re looking for assistance keeping up with rapidly changing processes and technology, we’d love to talk to you about our health plan benefits solutions. Contact us to learn more!

(Source: Risk & Insurance)

The COVID-19 Downturn Triggers Jump in Medicaid Enrollment

As the number of Covid cases began to rise in the U.S. so did the number of people applying for Medicaid. According to the CMS, as the country dips into a recession and millions of people lost their jobs, Medicaid saw an increase of 72.3 million in April, up from 71.5 million in March and 71 million in February. These numbers ended a three-year decline in Medicaid enrollment.

Some states, including Kentucky have created outreach programs to let people who applied for unemployment benefits know Medicaid and they have simplified the application process. The Kaiser Family foundation “estimated that nearly 13 million people who became uninsured after losing their jobs in March are eligible for Medicaid.” Read more.

(Source: Kaiser Health News)