THE 'EDGE REPORT BLOG

Preparing for Regulatory Changes from the New Administration

With the new presidential administration coming this week, most experts are projecting significant shifts in the healthcare space, especially related to health insurance coverage.

Some changes may come faster than others, but one thing is clear – healthcare is the dominant issue for the Biden Administration. Proposed changes range from regulatory actions related to the Public Option, Medicare, prescription drug reforms, and rules related to the Affordable Care Act, short-term limited-duration plans, association health plans, and Medicaid programs.

According to the Health Research Institute at PricewaterhouseCoopers, “Broadly, healthcare executives can expect an administration with an expansionary agenda, looking to patch gaps in coverage for Americans, scrutinize proposed healthcare mergers and acquisitions more aggressively and use more of the government’s power to address the pandemic.”

If health plans are managing policy updates and fee schedules internally, the responsibilities are ever-increasing. With Medicare's major quarterly updates being augmented by policy adjustments (such as COVID-19 vaccine administration policies and the Final Rule for 2021 Medicare Physician Fee Schedule, which includes new telehealth provisions) and retroactive changes, fee schedules require constant maintenance. The new administration's focus on healthcare reform will only add to this workload.

To address the many changes on the horizon, health plans need to automate these processes and make it easier to handle the lift associated with regulatory updates. They need technology solutions backed by policy experts that take care of the research and manage and load in fee schedules automatically, with rates and payment policies modified, tested, and operational on or before the effective dates.

Cloud-based delivery of up-to-date Medicare and Medicaid policies and fee schedules loaded and configured in a way that meets their specific business needs, mitigates risk from a compliance standpoint while simultaneously giving health plans a competitive advantage.

With the right technology, health plans don’t need to worry about the new administration's policy changes impacting their day-to-day business operations but can instead remain agile to new regulatory actions and a shifting marketplace. Which area do you want to focus on to bring the most value to your health plan?

Case Study
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A top insurance company with over 6 million members, was looking to grow their government business and streamline operations. In order to work at scale, they needed to fully automate their claims reimbursement process. Their legacy claims system was not designed to handle the complexities of new and innovative government programs, limiting their opportunities. Download the case study to learn how this large national insurer invested in payment integrity, saved millions of dollars annually, and propelled the Medicare Advantage business.

About the Author

Matt Brady

Matt Brady, Senior Marketing Manager, Burgess Group
LinkedIn
matt.brady@burgessgroup.com

Matt Brady has been with Burgess since 2017, serving a variety of needs within the Business Development team, including coordination of proposals, RFP responses, demonstrations, sales pipeline management, contracting, marketing and events. He holds a bachelor’s degrees from the University of Massachusetts and a master’s degree from Indiana University. He lives in Granby, Connecticut, just south of the Massachusetts border, with his wife and three young daughters.

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