There have literally been thousands of articles written over the past week on different aspects of the legislation. I've been reading many of them for both personal and professional reasons to learn about the law, review the different opinions, and most importantly, research the best ways to communicate it. I found that this one which discusses the most well-known changes that will take effect either immediately or eventually, as well as a brief description on some of the lesser known components of the bill, including:
Transparency in Insurance Companies
- Insurers must now reveal how much money is spent on overhead
- New plans must cover checkups and other preventative care without co-pays. All plans will be affected by 2018
- Non-profit organizations will be required to maintain a medical loss ratio -- money spent on procedures over money incoming -- of 85 percent or higher to take advantage of IRS tax benefits
- A two year temporary credit (up to a maximum of $1 billion) is in the bill to encourage investment in new therapies for the prevention and treatment of diseases
- New screening procedures will be implemented to help eliminate health insurance fraud and waste
- Medicare payment protections will be extended to small rural hospitals and other health care facilities that have a small number of Medicare patients
- Any new plan must now implement an appeals process for coverage determinations and claims
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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.
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