Ruling: Hospital bills should reflect ‘reasonable value’ of services

By Kathy Robertson An appellate court decision Tuesday in Fresno could have wide-ranging effects on hospitals and health plans in California. Read more…
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State Legislative/Regulatory News

Self-Insurance Institute of America, Inc. Exclusive Reporting for the Week of June 12, 2014 June 13, 2014 — This is your weekly update of state legislative/regulatory developments affecting companies involved in the self-insurance/alternative risk transfer marketplace. Should yo
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Hospital’s healthcare fee causes nothing but headaches

By David Lazarus The arthritis in Jill Smith’s knees can make walking unbearable. So she receives injections of an expensive pain medicine called Orthovisc once or twice a year. Read more…
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Overpayments… Over?

Ron E. Peck, Esq. Illinois Federal Court Issues a Troubling Decision Declaring Overpayment Recoupment to be Identical to Claim Denials; Requiring ERISA Compliant Notification of Adverse Benefit Determination, and Rights of Appeal for the Provider.
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More employers’ wellness programs matching employee interests: Study

By Matt Dunning Employers are making measurable progress in aligning their workplace wellness programs more closely with their employees’ needs and interests, according to a new report by wellness program provider Virgin Pulse. Read more…
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Medical stop-loss claims over $1M ballooned in 2013: Study

By Matt Dunning The frequency of catastrophic medical stop-loss insurance claims in excess of $1 million has risen dramatically in the last four years, according to a new report by Sun Life Financial Inc. Read more…
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Reform Update: Doctors play major role in ACOs, but surgeons largely left out

By Melanie Evans Doctors have a sizable role in the governance of the first private and public accountable care organizations, a study says. Surgeons, however, have been largely overlooked for executive committee memberships and in quality measures as Medicare ACOs develop early targe
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March ICD-10 testing delivers mixed results

By Joseph Conn Results from the initial March round of CMS claims process testing for the proposed ICD-10 conversion are being touted by the government, while at least one critic questions their meaning. Read more…
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Conn. health plans propose varied rates for 2015

By Paul Demko Two insurers selling products on Connecticut’s exchange want to raise premiums by double digits for 2015. But a third competitor is planning to reduce premiums by nearly 10%. Read more..
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Agency Addresses Payment Process for Employers & TPAs

Self-Insurance Institute of America, Inc. Special Communication June 2, 2014 — The Department of Health and Human Services (“HHS”) recently released a memo explaining the process for paying the assessment under the ACA’s “reinsurance program.” Unfor
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