Mnet Health News delivers the latest news and information articles for the world of healthcare.

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Obamacare Health Plans Vastly Different State to State

Little time is left until the new health insurance exchanges that came about as a result of the Affordable Care Act are open and selling health insurance to millions of people throughout the country. While this may be good news for those who did not previously have access to affordable health insurance, it is becoming clear that those who are planning to purchase their coverage through these exchanges will have very different choices depending on the area in the country that they live.

Some states such as Colorado, Maryland, and California have been able to attract many different insurers. California, for example, will have 13 insurers who are likely to offer a wide array of plans. Of the 13 insurers, there are notable names including some of most popular, best-known, and largest insurance carriers. But the story is drastically different for people in other states where options might be limited to a predominately local carrier or a completely unknown option, with no proven record in providing health coverage for individuals.

The Obama administration has suggested that the majority of Americans will have a choice of at least five carriers when open enrollment begins this October. There have also been encouraging signs that both existing and new insurers are working to provide plans that are competitive from the standpoint of affordability as well as creativity. These exchanges will be open to millions who are currently uninsured or who are already purchasing individual coverage for themselves and Federal subsidies will be available to many.

But people in some parts of the country may not have the same hearty level of insurance choices which means fewer insurers with instantly recognizable names to choose from. Inevitably, this will force some to take a chance on plans that are offered by insurers who are new to the individual health market and carriers who are brand new to the health insurance marketplace altogether. Not only will choices in providers be varying, but costs of insurance are expected to vary greatly as well.

It is probable that other companies will delay entry into the health insurance exchange until they see opportunity and the prospect of gaining new customers. The fact that there is a relative uncertainty over how well the exchanges will work and be received makes it likely that many companies will only enter the market after it is clear that a noteworthy number of customers exist.

The law was designed to encourage competition in the marketplace and, in fact, 25% of the companies offering plans on the 19 Federal exchanges are brand new to the marketplace according to a recent memo released. Using the State of Massachusetts as a case study for obvious reasons, it becomes apparent that a health plan that is new and unknown might not prevent it from becoming well-received quickly. In Massachusetts, an insurer that was basically unknown went on to capture a large share of the market. However, to remain competitive, insurers are going to have to search for opportunities to offer plans inexpensively.

Consumer-operated plans, or co-ops, will likely pressure other insurers to keep prices low since they might gain a larger market share by offering lower premiums. A consumer-operated insurer would typically charge little more than the actual costs of medical care and can even lower premiums when possible. Plans that specialize in Medicaid or government programs for low-income people might become an imposing competitor because they focus on serving their population segment.

Many within the insurance industry continue to speculate about how all of this will ultimately unfold. However, many knowledgeable industry insiders are conceding that it will likely take years for the new health exchange system to fully develop.

mistydawnphoto /


Health Care Coverage Still Uneven Across U.S.

On April 16, 2013, Gallup released a report showing that one in five Americans remain uninsured in 43 metro areas. Large discrepancies in health insurance coverage across the U.S. metro areas continued in 2012. However, according to Gallup, this may change as the centerpieces of the 2010 Affordable Care Act begin to go into effect – health insurance exchanges and the individual mandate.

The 10 metro areas with the highest percentage of uninsured residents are:

1. McAllen-Edinburg-Mission, Texas: 48.8 percent

2. El Paso, Texas: 31.7 percent

3. Yakima, Wash.: 31.0 percent

4. Naples-Marco Island, Fla.: 30.0 percent

5. Visalia-Porterville, Calif.: 29.8 percent

6. Bakersfield, Calif.: 28.7 percent

7. Salinas, Calif.: 27.9 percent

8. Stockton, Calif.: 27.8 percent

9. Las Vegas-Paradise, Nev.: 26.1 percent

10. Houston-Sugar Land-Baytown, Texas: 26.1 percent

The 10 metro areas with the lowest percentage of uninsured residents are:

1. Burlington-South Burlington, Vt.: 4.1 percent

2. Boston-Cambridge-Quincy, Mass.-N.H.: 4.3 percent

3. Springfield, Mass.: 4.8 percent

4. Worcester, Mass.: 5.6 percent

5. Ann Arbor, Mich.: 6.3 percent

6. Rochester, N.Y.: 6.4 percent

7. Madison, Wis.: 6.7 percent

8. Barnstable Town, Mass.: 7.1 percent

9. Harrisburg-Carlisle, Pa.: 7.5 percent

10. Buffalo-Niagara Falls, N.Y.: 7.9 percent

The 2012 metro area data were collected as part of the Gallup-Healthways Well-Being Index. The nationwide adult uninsured rate of 16.9 percent in 2012 was similar to the 17.1 percent in 2011, but remains up from 2008 (14.8 percent) and 2009 (16.2 percent). The metro areas with the highest and lowest uninsured rates have changed little over time.


Rule Finalized Guaranteeing 100 Percent Funding for New Medicaid Beneficiaries

The U.S. Department of Health and Human Services (HHS) announced a final rule with a request for comments that provides, effective Jan. 1, 2014, the federal government will pay 100 percent of the cost of certain newly eligible adult Medicaid beneficiaries. These payments will be in effect through 2016, phasing down to a permanent 90 percent matching rate by 2020. The Affordable Care Act authorizes states to expand Medicaid to adult Americans under age 65 with income of up to 133 percent of the federal poverty level (approximately $15,000 for a single adult in 2012) and provides unprecedented federal funding for these states.

The final rule provides important information to states that expand Medicaid. It describes the simple and accurate method states will use to claim the matching rate that is available for Medicaid expenditures of individuals with incomes up to 133 percent of poverty and who are defined as “newly eligible” and are enrolled in the new eligibility group. The system is set up to make eligibility determinations as simple and accurate as possible for state programs.

Under the Affordable Care Act, states that cover the new adult group in Medicaid will have 100 percent of the costs of newly eligible Americans paid for by the federal government in 2014, 2015 and 2016. The federal government’s contribution is then phased-down gradually to 90 percent by 2020, and remains there permanently. For states that had coverage expansions in effect prior to enactment of the Affordable Care Act, the rule also provides information about the availability of an increased Federal Medical Assistance Percentages for certain adults who are not newly eligible.


24 States Have Selected Their Benchmark Health Insurance Plan for Essential Health Benefits

Twenty-four states and the District of Columbia have selected the health insurance plan in their state that will serve as the “essential health benefit” package sold by all insurers participating in the new health insurance marketplace and the individual and small-group markets beginning January 2014, according to a Commonwealth Fund study announced on March 13, 2013. The essential health benefit covers 10 broad service categories, including ambulatory patient care, hospitalization, maternity and newborn care, and prescription drugs. The federal government allowed each state to choose a benchmark plan to help meet the Affordable Care Act requirement that the essential health benefit reflect a typical employer health insurance plan.

The authors of the study found that 19 of the states that selected plans chose existing small-group plans—typically employer-based plans for businesses with fewer than 50 employees. The remaining five states selected HMO or state employee benefit plans. For states that did not select a benchmark plan, the federal government will designate the largest small-group plan in the state as the benchmark, meaning that the majority of states will have the most widely purchased small-group plan in the state as the basis of their essential health benefit.

In an in-depth investigation into how 10 states arrived at their benchmark plan, the authors found that states conducted analyses of plan enrollment and costs, and engaged consumer and patient groups, insurers, and specialty physicians in their decision-making process. The desire to preserve state benefit mandates not included in the federal essential health benefit package was also a factor in choosing benchmark plans.

The Department of Health and Human Services (HHS) will evaluate the benchmark selection process and may choose to revisit it in 2016. If that is the case, the authors recommend that the federal government establish minimum standards that states must use when selecting their benchmark plans.


Patients May be Reluctant to Focus on Costs

One proposed initiative to cut health care spending is to get patients involved in weighing costs of treatment options when making medical decisions. A recent study in Health Affairs assessed patients’ willingness to consider costs when choosing care options.

Following a study of twenty-two focus groups of insured individuals, researchers identified four barriers to patients’ willingness to consider comparable lower cost care options.

• Preference for what patients perceive as the best care, regardless of expense;

• Inexperience with making trade-offs between health and money;

• Lack of interest in costs borne by insurers and society as a whole;

• Noncooperative behavior characteristics of a “commons dilemma,” in which people act in their own self-interest despite recognizing, they are depleting limited resources.

According to the abstract, “Surmounting these barriers will require new research in patient education, comprehensive efforts to shift public attitudes about health care costs, and training to prepare clinicians to discuss costs with their patients.”


HIPAA Omnibus Final Rule

On Jan. 17, 2013, the U.S. Dept. of Health and Human Services released the long-awaited omnibus final rule designed to strengthen the privacy and security protections for health information afforded under the Health Insurance Portability and Accountability Act (HIPAA). Such changes marked the most sweeping changes to the HIPAA Privacy and Security Rules since they were first implemented. The omnibus final rule is comprised of four final rules, discussed below. Please note this article is intended only to provide an overview of several of the notable provisions within the omnibus final rule; however, it is not an exhaustive explanation of the rule.

HIPAA Privacy, Security and Enforcement Rules

The final rule provides modifications to HIPAA’s Privacy, Security and Enforcement Rules mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act, as well as other modifications to improve the rules. Amongst the major changes, the modifications make clear that certain HIPAA Privacy and Security Rules apply directly to business associates (BAs), in the same manner that the requirements apply to covered entities, and that BAs are civilly and criminally liable for violations of such provisions. The final rule also expands the definition of “business associate” to include certain personal health record vendors and subcontractors under HIPAA’s umbrella. Notably, the new rule fails to define the “minimum necessary standard,” rather HHS stated that how a BA will apply the minimum necessary standard will vary based on circumstances, and that BA agreements should limit the BA’s use and disclosure of protected health information (PHI) in accordance with the covered entity’s minimum necessary policies and procedures. HHS noted that it intends to issue further guidance on the minimum necessary standard. The rule also expands individuals’ rights by permitting patients to request electronic copies of health information. Additionally, patients may instruct a provider not to share treatment information with their health plan when the individual pays for such service out of pocket, in full. The rule also strengthens the limitations on the use and disclosure of PHI for marketing and fundraising purposes, and generally prohibits the sale of PHI for remuneration without the individual’s authorization. Under the rule, covered entities are required to make modifications to privacy notices and redistribute the revised notices. The rule also attempts to streamline individuals’ ability to authorize the use of their health information for research purposes and make it easier for parents and others to provide proof of child immunization to schools.

Civil Money Penalty Structure

The final rule adopts the HITECH Act’s tiered structure of increasing penalty amounts that correspond to the levels of culpability associated with a violation. The first category (lowest penalty tier) covers situations where the covered entity or BA did not know, and by exercising due diligence would not have known, of a violation. The second category (next highest penalty tier) applies to violations due to reasonable cause. The final rule clarifies that “reasonable cause” means “an act or omission in which a covered entity or business associate knew, or by exercising reasonable diligence would have known, that the act or omission violated an administrative simplification provision, but in which the covered entity or business associate did not act with willful neglect.” The third and fourth categories apply to circumstances where the violation was due to willful neglect that is corrected within a certain time frame (second highest penalty tier) and willful neglect that is not corrected (highest penalty tier). While HHS has discretion to determine the amount of penalty to impose within each tier, HHS reiterated that the Department would not impose the maximum penalty amount in all cases. Instead, the penalty amount would be determined on a case-by-case basis, depending on the nature and extent of the violation and resulting harm, as well as the financial condition and size of the covered entity or BA. Further, the final rule clarifies that a covered entity may be held liable for the acts of its agents. The rule states that whether a BA is considered an agent of a covered entity will be fact specific, taking into account the terms of the BA agreement and the totality of the circumstances involved in the relationship between the parties.

Breach Notification for Unsecured Protected Health Information

The final rule modifies the definition of “breach” and the risk assessment factors for determining whether a breach has occurred. Under the revised definition of “breach,” an impermissible use or disclosure of PHI is “presumed to be a breach unless the covered entity or business associate, as applicable, demonstrates that there is a low probability that the protected health information has been compromised.” This low-probability standard replaces the “significant risk of harm” standard set forth in the interim final rule published on Aug. 24, 2009. HHS clarified that breach notification is not required if a covered entity or BA demonstrates through a risk assessment that there is a low probability that the PHI has been compromised. The final rule outlines the factors that covered entities and BAs must consider when performing a risk assessment. Such factors include, at minimum, (1) the nature and extent of the PHI involved, including the types of identifiers and the likelihood of re-identification; (2) the unauthorized person who used the PHI or to whom the disclosure was made; (3) whether the PHI was actually acquired or viewed; and (4) the extent to which the risk to the PHI has been mitigated. HHS recommends that covered entities and BAs examine their policies to ensure that all required factors are considered when conducting a risk assessment to determine whether a breach has occurred.

Genetic Information Nondiscrimination Act (GINA)

The final rules also modifies the HIPAA Privacy Rule as required by the Genetic Information Nondiscrimination Act (GINA) to prohibit most health plans from using or disclosing genetic information for underwriting purposes.

The new rule is effective March 26, 2013, with a compliance date of Sept. 23, 2013. The final rule may be viewed in the Federal Register at


Multiple entities collecting on same account

To avoid confusion, misrepresentation, and excessive contacts, providers and their collection partners should exercise caution to ensure only one entity is collecting on an account at a time.

When forwarding an account 
for collection, health care providers should cease internal collection efforts and refrain from placing the account simultaneously with multiple collection partners.

If more than one entity attempts to collect a debt at the same 
time, the consumer may become confused as to which entity is actually collecting the debt and who to contact for payment, complaints or other inquiries. Additionally, payments made on the account will likely be credited only with the entity that received payment rather than with all parties collecting on the account, leading to inaccurate account balances.

The amount of the debt may also vary depending on collection costs—as collection costs added to outstanding account balances are presumably different between agencies and a collection agency may be seeking collection costs while the provider is not. Consequently, if more than one entity at a time collects an account (either multiple collection agencies or a collection agency and a provider), a misrepresentation of the debt is bound to occur, as payments may not be credited by all the parties seeking collection and the amount owed may be different at each agency.

Further, a consumer will likely be contacted more frequently when multiple parties are attempting to collect on the same debt, which could frustrate or irritate the consumer. Such actions could also result in violations of the Fair Debt Collection Practices Act, which governs the practices of most third-party debt collectors.

Written by Pulse

For more information, please contact David Brooks via email at or by phone at (949) 900-6125 x205


Healthcare Collections Adapt to the World of Mobile Technology

Technology is making it easier than ever before to conduct business intelligently. Mobile technologies, such as smartphones and tablet computers, are positioned to change the way that collection vendors conduct business with clients and their patients. In fact, many collection vendors are using mobile technology to increase efficiency, add accessibility, and improve the collection experience.

A recent Pew Research report pointed out that 44% of U.S. adults currently own and use a smart phone, 18% of adults own and use a tablet, and these numbers are growing rapidly. “A significant cross-section of the population now has access to smartphones, tablets or notepad computers,” states David Hamilton, CEO of Mnet Financial, “and use of these devices is increasing healthcare collections and patient satisfaction.”

Apps and Mobile-Ready Websites

Tablet computers and smartphone applications, or “apps,” appear to be here for the long-term; the downloading and use of apps has increased each year since their introduction. In the collection world, apps and mobile-ready websites can be extremely beneficial because they give patients the opportunity to pay their bills conveniently anytime and from anywhere.

“The more tools that you provide for the patient to use, the more likely you will be to get the debt resolved,” explains Hamilton. “When a collection vendor pays attention to patient needs, the patient’s interactions with the vendor are greatly enhanced and a positive experience and sense of rapport are felt.” A self-pay portal should be a part of any app used by a collection vendor. A patient should have the ability to easily make payments using a credit card, debit card, or electronic check; be able to communicate with a representative of the company; and have the ability to review balance information as well.

Mnet Financial is at the forefront of these new technologies. “Our goal is to give our clients’ patients every possible option available so that they can bring about a resolution to their medical debt,” states Stacy Eaton, Mnet Financial Collection Manager. “That’s why our website was created to be compatible with mobile devices. When a patient uses a smartphone or other mobile device to visit our website, the mobile version is automatically accessed, giving the patient easy access to a full range of debt resolution tools.”

Applications and mobile-ready websites are prime examples of how the collection industry is adapting to meet the needs of patients and providers in the world of mobile technology, but they are not the only options. Watch for the next installment of “Healthcare Collections Adapt to the World of Mobile Technology,” as we discuss the topic further.

Written by Mnet Financial


CMS Releases Stage 2 EHR Criteria

On March 7, 2012, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule outlining Stage 2 standards for certified electronic health records (EHR) and extending the effective date of Stage 2 requirements one year. Providers now have until 2014, rather than 2013, to implement Stage 2 meaningful use criteria.

The Health Information Technology for Economic and Clinical Health (HITECH) Act established programs under Medicare and Medicaid to provide incentive payments to eligible professionals and eligible hospitals that adopt and make "meaningful use" of EHR technology.

Under the HITECH Act, the Medicare EHR incentive programs provide incentive payments to eligible professionals, eligible hospitals, and critical access hospitals that are meaningful users of certified EHRs.

CMS has established a three-stage approach to implement the requirements for demonstrating meaningful use, each with different implementation dates and varying requirements for establishing meaningful use.

Initially, reasonable criteria for meaningful use are based on currently available technological capabilities and providers' practice experience. Over time more extensive criteria will be required as developments in technology and providers' capabilities advance.

Stage 1, which began in 2011, sets forth a set of 15 core objectives eligible professionals must meet and 14 core objectives hospitals must meet. Eligible professionals and hospitals must choose five "menu" requirements to satisfy the meaningful use criteria. Some objectives set forth in the rule for Stage 1 are:
- Implement drug-drug, drug-allergy, drug-formulary checks.
- Report information for quality improvement and public reporting.
- Maintain an up-to-date problem list of current and active diagnoses
- Generate and transmit permissible prescriptions electronically (eRx).
- Use computerized physician-order entries (CPOE), which is defined as entailing the provider's use of computer assistance to directly enter medical orders (for example, medications, consultations with other providers, laboratory services, imaging studies, and other auxiliary services) from a computer or mobile device.

Under the recent proposed rule, Stage 2 meaningful use requirements will include rigorous expectations for health information exchange, including more demanding requirements for e-prescribing, incorporating structured laboratory results, and the expectation that providers will electronically transmit patient care summaries to support transitions in care across unaffiliated providers, settings and EHR systems.

Stage 2 also expands on Stage 1 criteria in the areas of disease management, clinical decision support, medication management support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies.

These changes will be reflected by a larger number of core objective requirements for Stage 2. Every objective that is optional in Stage 1 will be required in Stage 2. All menu set items likely will be moved to core measures, percentages will be increased, and some new menu objectives will be added. For example, under the proposed Stage 2 regulations to qualify for meaningful use payments hospitals, physicians and other eligible professionals will have to place orders through CPOE for more than 60 percent of their medication, laboratory and radiology orders. Under Stage 1, there is only a 30 percent CPOE threshold and only medication orders are counted.

To view a full list of Stage 2 "core" and "menu" set objectives, see the HHS proposed rule available at:

For Stage 3 of the meaningful use criteria, beginning in 2016, the proposed rulemaking focuses on promoting improvements in quality, safety and efficiency, decision support for national high priority conditions, patient access to self-management tools, and access to comprehensive patient data and population health. Stage 3 will also provide higher standards for meeting meaningful use. Further clarification regarding Stage 3 requirements will be released as the effective date nears.

Written by Pulse


Uninsured Rate for 18- to 25-Year-Olds Levels Off

The Gallup-Healthways Well-Being Index survey found the percentage of 18- to 25-year-old Americans without health insurance has plateaued at the 24 percent range, after declining from about 28 percent after the health care law provision allowing adults up to age 26 to stay on a parent's plan was implemented.

The uninsured rate for 18- to 25- year olds remained at 24 percent in the first quarter of 2012. The uninsured rate for this group first began to decline in the fourth quarter of 2010, decreasing to 26.3 percent from 28.0 percent in the third quarter of that year. The rate then decreased to 24 percent in the first quarter of 2011 and has remained around that level since.

The survey also stated that the uninsured rate for 26- to 64-year olds also leveled off, with one in five Americans in this age group reporting not having health insurance for the past year.

Gallup-Healthways Well-Being Index also showed the percentage of seniors who are uninsured has remained the same over the past four years. Very few adults aged 65 and older report not having health insurance, likely because they qualify for Medicare.

The Well-Being Index indicated the percentage of all adults who get their health insurance through an employer has declined to 44.5 percent. The percentage of adults who have a government plan through Medicare, Medicaid or military/ veterans' benefits has increased over time, now at 25.3 percent. The percentage of Americans who say they get their health insurance through "something else," which could mean they purchase it themselves, has held steady near 11 percent over the years.

According to results from the Gallup-Healthways Well-Being Index survey, the percentage of all U.S. adults without health insurance was 17.3 percent in the first quarter of 2012, similar to its levels for the past year, although clearly lower than in 2008, 2009 and 2010, before the health care law provision took effect.

Written by Pulse


Who's Using a Hospital System's Social Media Page and Why?

Researchers found that more than 71 percent of individuals using Summa Health System's social media platforms already used social media to seek personal health information.

Summa researchers distributed an Internet-based survey on the hospital's Facebook, Twitter and blog and received feedback from more than 150 respondents. The survey sought to map out the user characteristics of a hospital system's social media structure and why users were using the hospital's social media pages.

According to the findings, 95.5 percent of respondents were female and 93.6 percent were Caucasian. Respondents were mostly age 50- 59 (33.8 percent) and 40-49 (26 percent). Sixty percent reported having a bachelor degree or higher. Aside from seeking personal health information (71.5 percent), social media was used to seek family health information (29 percent) and for hospital programming (27 percent).

The study's author concluded that hospitals have a huge opportunity to discuss health issues with patients using social media platforms. Hospitals, however, must still be cautious of HIPAA concerns and online professionalism.

Written by Pulse


More than 100,000 Providers Paid for Using Electronic Health Records

More than 100,000 health care providers are using electronic health records that meet federal standards and have benefitted from the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) announced on June 19, 2012.

The EHR Incentive Programs, established by the Health Information for Clinical and Economical Health Act of 2009, provide incentive payments to eligible professionals, hospitals, and critical access hospitals as they adopt, implement, upgrade, or meaningfully use certified EHR technology in ways that improve care.

As of the end of May 2012:
- More than 110,000 eligible professionals and over 2,400 eligible hospitals have been paid by the Medicare and Medicaid HER Incentive Programs.
- Approximately 48 percent of all eligible hospitals and critical access hospitals in the U.S. have received an incentive payment for adopting, implementing, upgrading, or meaningfully using an EHR.
- One out of every 5 Medicare and Medicaid eligible professionals in the U.S. has received an incentive payment for adopting, implementing, upgrading, or meaningfully using an EHR.
- Over $5.7 billion in EHR Incentive Program payments were made.
- More than $3 billion in Medicare EHR Incentive Program payments were made between May 2011 (when the first payments were released) and the end of May 2012.
-More than $2.6 billion in Medicaid EHR Incentive Program payments were made between January 2011(when the first states launched their programs) and the end of May 2012.

Written by Pulse

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