NEW RULES:Bans on balance billing and out-of-network cost-sharing

Effective Jan. 1, 2022, Health Plan commercial members will be protected from balance billing after receiving emergency care and nonemergency care from certain out-of-network providers at in-network facilities. The No Surprises Act, which is included within the Consolidated Appropriations Act of 2021 (the CAA), provides the following:

Changing Demographics & Value-Based Care

  Changing Demographics & Value Based Care The U.S. is stuck in a system of volume-based (fee-for-service) care that continues to drive up costs without providing better outcomes for patients.…

Improving Payment Accuracy In Health Insurance Marketplaces

In all three countries studied, risk adjustment leaves some enrollees highly underpaid and others highly overpaid. In the U.S. exchanges, for example, one in a thousand enrollees were underpaid by more than $190,000, and one in a thousand were overpaid by at least $95,000 in 2017.

Biofourmis Launches Its Chronic Condition Management Platform

The Biofourmis Care platform currently supports five virtual care programs: heart failure, hypertension, diabetes, lipid management, and atrial fibrillation. The technology platform facilitates care coordination across care settings and provider organizations and supports user communications with the care team. Biovitals, the Biofourmis artificial intelligence-powered predictive analytics engine, analyzes the data from the consumer wearables.

No Surprises Act

On January 1st, 2022, the No Surprises Act went into effect and it provides federal protections for patients from surprise medical bills.

Prescription digital therapeutics (PDTs)

Prescription digital therapeutics (PDTs) are software applications that are prescribed by a licensed healthcare provider.

Digital therapeutics (DTx)

Digital therapeutics (DTx): Deliver therapeutic, evidenced-based interventions driven by software to treat, manage, and prevent a broad spectrum of behavioral, mental, and physical diseases and disorders.

Talking about Mental Health at Work

Tools and Partnerships to help your organization raise awareness, reduce stigma surrounding mental illness, and facilitate help-seeking behavior. MENTAL HEALTH @ WORK Treatment can help people feel better and perform…

Managed Care Contracts and Health System Operational Alignment

CASE EXAMPLE of how we breakdown contracts and tie the terms to operational alignment Because the business of healthcare is to deliver the highest quality care to patients, improving clinical…

Nurse Practitioners Sentenced to Prison for Health Care Fraud

GREAT  FALLS – Two Montana nurse practitioners have been sentenced for conspiring to defraud Medicare of millions of dollars.  Chief U.S. District Judge Brian Morris sentenced Janae Nichole Harper, 34, of Kalispell, to 12 months in prison and Mark Allen Hill, 54, of Edinburg, North Dakota to 9 months in prison. 

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