Softheon

CMS Continues Mission on Integrity with Affiliations Final Rule

Last week, the owner and CEO of Video Doctor Network pled guilty to a $424 million Medicare kickback scheme. He admitted to receiving kickbacks and bribes from recruiters, pharmacies and brace suppliers in turn for arranging doctors to order medically unnecessary orthotic braces for Medicare beneficiaries. As reported by Healthcare Dive, this is one of the largest schemes to defraud Medicare ever investigated by the Federal Bureau of Investigation (FBI) and the Health and Human Services (HHS) Office of the Inspector General and prosecuted by the Department of Justice.

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Product Talk: Enhanced Direct Enrollment

Softheon’s private-label enrollment solution, Enhanced Direct Enrollment-as-a-Service (EDE) offers a unified enrollment experience and an updated, easy-to-use portal for Marketplace members. Now available to any health plan engaged in the ACA Marketplace once it informs CMS that it is partnering with Softheon as an EDE vendor, Softheon EDE uses a series of Centers for Medicare and Medicaid Services-based (CMS) application program interfaces (APIs) to process eligibility and changes behind the scenes. In this interview, we spoke with Min Kyu Han, one of EDE’s product owners.

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HMA Conference Recap

Bisma M.
September 11, 2019
Affordable Care Act / Conferences / Medicaid
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The Health Management Associates (HMA) conference brought together hundreds of industry executives from health plans, governments and community-based organizations serving Medicaid, Medicare and vulnerable populations. Set in Chicago, Illinois, the conference shed a light on the challenges and opportunities for health care entities in the publicly sponsored health care arena.

In case you were not able to attend, here is a recap of the key topics discussed:

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Maine the Latest to Join the SBM Groundswell

Bisma M.
September 9, 2019
Affordable Care Act / Medicaid / State & Federal Insurance Exchanges
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To improve the state’s ability to fund education and outreach, Maine Governor Janet Mills submitted a letter of intent last week to the Centers for Medicare and Medicaid Services (CMS) to become a state-based marketplace on the federal platform (SBM-FP).

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North Carolina’s HHS-backed Health Care Venture

Bisma M.
August 30, 2019
Affordable Care Act / healthcare payers / Providers
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What if instead of paying doctors based on their number of visits with patients we paid them based on how well they improved the health of their patient? Say how well they controlled a diabetic patient’s blood sugar or a heart attack patient’s cholesterol?

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CMS Recap: Star Ratings, Declining Enrollment, Declining Premiums

Bisma M.
August 26, 2019
Affordable Care Act / Medicaid / State & Federal Insurance Exchanges
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Between the Center for Medicare and Medicaid Services’s (CMS’s) recent release of the Early 2019 Effectuated Enrollment Report and the Trends in Subsidized and Unsubsidized Enrollment Report and CMS’s newly…

MESC Recap: Day 3 & 4

The Medicaid Enterprises Systems Conference (MESC) ended on a positive note by discussing how analytics has been used by state Medicaid agencies to solve the opioid crisis and how Florida has successfully modernized its member service experience.

In case you were not able to attend, here is our recap of the key topics discussed:

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MESC Recap: Day 2 & 3

The Medicaid Enterprise Systems Conference (MESC) continued day 2 and day 3 by discussing the most pertinent issues facing Medicaid: modularity, user acceptance testing, automation, mobility and enterprise transformation. Attendees are addressing state challenges and keeping the Medicaid modernization at the forefront of proposed solutions.

In case you were not able to attend, here is our recap of key topics discussed:

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MESC Recap: Day 1 & 2

Bisma M.
August 21, 2019
Conferences
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The Medicaid Enterprises Systems Conference (MESC) kicked off with a series of sessions pushing attendees to think about how to improve health care, Medicaid, and associated technologies. Set in Chicago, Illinois, the conference is an annual meeting for state, federal and private sector individuals to provide opportunities for the exchange of ideas related to Medicaid systems and health policy affected by those systems.

In case you were not able to attend, here is a recap of the key topics discussed:

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A Prescription for a Passport? Health Plans Covering Medical Tourism

No longer limited to the wealthy pursuing cosmetic surgeries and cutting-edge treatments overseas, medical tourism has become a solution for the low-income and uninsured. 1.9 million Americans will travel outside the U.S. for medical care this year, according to Patients Beyond Borders.

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