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The Affordable Care Act (ACA) established the health insurance rate review program in order to protect consumers from unreasonable rate increases. [1] Through this program, proposed premium increases in the small group and individual markets that are above a threshold amount (ten percent or more, as of February 2014) are reviewed by states or the federal government to determine whether the ...
Reviews in 2008 and 2009 review of research on the effects of health care ratings found that there was evidence that public ratings drove hospitals to improve their performance, but there was limited evidence that they affected how consumers choose health care providers or insurance plans, or that they changed the performance of individual ...
Its website evaluates roughly 500 million claims from federal and private reviews and data to rate and rank doctors based on complication rates at the hospitals where they practice, experience, and patient satisfaction. [8] Its analysis is based on approximately 40 million Medicare discharges for the most recent three-year time period available ...
CAQH was formed by a number of the nation's largest health insurance companies with the goal of creating a forum for healthcare industry stakeholders to discuss administrative burdens for physicians, patients, and payers. [5] CAQH is a group of health insurance companies that sets rules and coordinates information for physicians and other ...
In 2015 CMS identified 254 quality measures for which providers may choose to submit data. The measures map to U.S. National Quality Standard (NQS) health care quality domains: [4]
Administrative data are electronic records of services, including insurance claims and registration systems from hospitals, clinics, medical offices, pharmacies and labs. For example, a measure titled Childhood Immunization Status requires health plans to identify 2-year-old children who have been enrolled for at least a year.
The other related issue concerned advance-care planning consultation: a section of the House reform proposal would have reimbursed physicians for providing patient-requested consultations for Medicare recipients on end-of-life health planning (which is covered by many private plans), enabling patients to specify, on request, the kind of care ...
The Medicare Shared Savings Program is a three-year program during which ACOs accept responsibility for the overall quality, cost and care of a defined group of Medicare Fee-For-Services (FFS) beneficiaries. Under the program, ACOs are accountable for a minimum of 5,000 beneficiaries. [21]