Medicaid Before, During, and After the COVID-19 Public Health Emergency

Remember when there wasn’t a pandemic? COVID-19 has rocked our world and has left its mark on a new generation. It has also shape-shifted the Medicaid program. States will need to figure out how to return Medicaid to the pre-COVID-19 program it was. What does that mean for payors, providers, and beneficiaries? This article takes…

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Emergency Declarations and Their Medicaid Impacts

A few state Governors are ending the public health emergency (PHE) declaration for their state, with more to follow. This is causing concern and confusion in the Medicaid provider and health plan communities. Providers are concerned about a sudden increase in the uninsured while Medicaid managed care plans are concerned about a sudden drop in…

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Affordable Care Act Anniversary: There’s Still More Work To Do

What year was it? The number of non-elderly uninsured Americans was 48.2 million (18.2%) Uninsured children under the age of 18 was 9.8% Employer-sponsored insurance covered 55.3% of the population 5% of the population was covered by Medicare 9% of the population was covered by Medicaid with some individuals covered by Medicare and Medicaid Medicaid…

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Riding Off Into the RAPS Sunset

“Every sunset is an opportunity to reset.” – Richie Norton “Sunsets are proof that no matter what happens, every day can end beautifully.” – Kristen Butler “Beautiful sunsets need cloudy skies.” – Paulo Coelho Most of us can appreciate the beauty and splendor of a beautiful sunset and all that it represents, such as the…

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Understanding the Differences Between Medicare and Medicaid

Medicare and Medicaid are two separate and commonly misunderstood programs, even among healthcare professionals. Centauri Health Solutions wants to help clarify the differences. Medicare was designed to protect people in retirement. Originally, it included Part A, which is hospital insurance, and Part B, which covers medical care outside of a hospital admission. Medicare pays the…

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Federal Poverty Guidelines 2021 Release

The 2021 Poverty Guidelines were posted today at https://aspe.hhs.gov/poverty-guidelines and in effect as of January 13, 2021. The Federal Register notice for the 2021 Poverty Guidelines will be published the week of January 18 through January 22, 2021. Payers and Providers wait for the release of the poverty guidelines each year to update patient financial…

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Hospital Price Transparency

Effective January 1, 2021, hospitals are required to post standard charges in a machine-readable file and post their negotiated rates online for 300 “shoppable” services, 70 of which are pre-selected by the Centers for Medicare and Medicaid Services (CMS). “Standard charges” include the gross charges, payer-specific negotiated charges, the amount the hospital is willing to…

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Social Determinants of … HELP!

Perhaps you have more questions than answers about the Social Determinants of Health, such as: Why are social determinants important? Should I look at the community at large or individuals? Where do I start? How do I know if my patient or member population has unmet needs? What is a Z Code? How much money…

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Enrollment Assistance: A Difference Maker

Printed materials, educational question and answer sessions, and dedicated, live resources are all part of my employer-sponsored insurance (ESI) annual open enrollment experience. I take advantage of this enrollment assistance each year and would be lost without it. The same holds true for the hospital patients and health plan members Centauri Health Solutions (“Centauri”) assists…

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What You Need to Know: Key Changes for HEDIS MY2020

There have been a lot of changes with HEDIS® for MY2020.  We’ve highlighted key changes in the Volume 2 specifications until the final changes become available on October 1. The first change to note is that NCQA has instituted a new naming convention to reduce confusion about the measurement year vs. reporting year. Going forward,…

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