Supreme Court to rule on federal employee health insurance

By Miracle Jones [JURIST] The US Supreme Court [official website] on Friday granted certiorari [order, PDF] in Coventry Health Care of Missouri, Inc. v. Nevils [docket; cert. petition, PDF] to determine if health care companies are precluded from recouping reimbursements under the Fed
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California Senate Approves Reference Based Pricing

MyHealthGuide Source: Ana B. Ibarra, 8/30/2016, California Healthline and Senate Bill AB-72 Article referred by Bill Rusteberg, RiskManagers.us A measure to protect California consumers from surprise medical bills — among the longest-debated issues to be considered by state lawm
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CMS penalizes 2.6k hospitals for high readmissions: 5 statistics

By Brooke Murphy In fiscal year 2017, CMS will withhold $528 million in Medicare reimbursements to hospitals with higher-than-expected readmission rates as part of the Hospital Readmissions Reduction Program, reports Kaiser Health News.
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CMS and FDA advocate for device identifiers on claims forms

By Adam Rubenfire The heads of the CMS and the Food and Drug Administration want universal health insurance claims forms to include unique device identifiers. The UDI would improve post-market surveillance and provide for better value-based reimbursement based on device performance, t
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Ga., Calif. Hospitals Sue Blue Cross Plan For Sending ER Reimbursements To Patients

By Andy Miller Blue Cross and Blue Shield of Georgia faces separate lawsuits accusing it of sending reimbursement money for emergency room care directly to patients — and not to the hospital because it isn’t part of the insurer’s network. Read more…    
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Massachusetts health care pricing compromise reached to avert ballot question

By Shira Schoenberg | sschoenberg@repub.com BOSTON — A compromise announced Wednesday by Gov. Charlie Baker and Massachusetts House and Senate leaders may avert the need for a ballot question to regulate commercial insurance payments to hospitals. Read more…
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Plan’s Reimbursement in Third-Party Recovery Case Limited by Plan Terms and Common-Fund Doctrine

Topic(s): ERISA Compliance for Health & Welfare Plans; Self-Insured Health Plans US Airways, Inc. v. McCutchen, 2016 WL 1156778 (W.D. Pa. 2016) After a plan participant was injured in a car accident and recovered money from third parties, the plan administrator sought reimbursemen
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Court Nixes Health Plan’s Subrogation Claim

Posted December 22, 2015, 3:11 P.M. ET By Carmen Castro-Pagan A health plan isn’t entitled to reimbursement of $48,000 in medical expenses it paid on behalf of a minor beneficiary who was injured in an all-terrain vehicle accident, the U.S. District Court for the District of Ari
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The Supreme Court Seeks Solutions to the Latest Challenges to Subrogation Rights in Montanile Case

By Catherine Dowie The facts of the latest healthcare subrogation challenge on the SupremeCourt’s docket (Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan) will be familiar to many. As you may recall from the June 2015 article,“TheRoad to Recovery:
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FEHBA Preempts Kansas Anti-Subrogation Regulation

By Carmen Castro-Pagan The Federal Employees Health Benefits Act preempts a Kansas administrative regulation prohibiting subrogation and reimbursement clauses in health insurance contracts of federal government employees, the U.S. Court of Appeals for the Tenth Circuit ruled . The app
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