Federal Judge Blocks Proposed Health Insurer Aetna-Humana Merger
The proposed merger of Aetna Inc. and Humana Inc. was blocked by a United States Federal Judge earlier this week. Read more about this in the article below. nnA U.S. judge blocked on Monday health insurer Aetna Inc’s proposed $34 billion acquisition of smaller peer Humana Inc, raising the stakes for rival Anthem Inc as it battles to close a $54 billion deal to buy Cigna Corp. The ruling is another victory for the U.S. Justice Department, whose antitrust enforcement became much more aggressive during former U.S. President Barack Obama’s eight years in office, which ended last week.nnObama’s successor, Donald Trump, and a Republican-controlled legislature are seeking to undo much of the Affordable Care Act, better known as Obamacare. The law reshaped the U.S. healthcare industry by mandating health insurance and creating online exchanges where consumers can shop for individual policies and get subsidies. Aetna, Humana, Anthem and Cigna had cited Obamacare as one of the main reasons their industry needed to consolidate to cope with the costs of expanding coverage. Their shares ended trading on Monday at levels that suggested that investors continued to see little chance that the two mergers would happen.nnThe U.S. Justice Department filed a lawsuit last July to block Aetna’s acquisition of Humana and Anthem’s acquisition of Cigna, arguing that the two deals would lead to higher prices. Anthem and Cigna are still waiting for a judge to rule on whether their merger can proceed. Investors have long been skeptical that this deal can be approved, and Leerink Research analyst Ana Gupte reiterated on Monday that she expected to also see this deal blocked. In his ruling, Judge John Bates of the U.S. District Court for the District of Columbia said the proposed deal would “substantially lessen competition” in the sale of Medicare Advantage plans in 364 counties in 21 states that the Justice Department had identified in its complaint, and on the Obamacare exchange in three Florida counties.n
nThis article was originally posted on Reuters.com.
The Affordable Care Act (Obama Care) looks to be the first target of a Republican dominated House, Senate and President!nnMuch in the ACA is entangled in the current tax code. It will not be as simple as defunding it. The employer and individual mandates, the premium tax credit, the (so called) Cadillac Tax, the earned income surtax (just to name a few examples) will all have to be revisited.nnBe on the lookout for big and potentially complicated tax changes as our President and legislators unwind this enormous law we now call Obama Care.nnWhile we are at it, just an FYI: The shorter depreciation schedule for race horses appears to be expiring!nnPlease consult your tax professional for more details and information prior to making any changes!nn
About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare Partners
Tom Price’s Vision – Commercial & Individualn
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Moderate sedation services have historically always been bundled into the majority of all applicable CPT procedures. More than 400 codes that were previously defined as including moderate sedation have been deleted from Appendix G. In addition to six new CPT codes and one new endoscopy-specific HCPCS code, CMS intends to create a “uniform methodology for valuation of the procedural codes that currently include moderate sedation as an inherent part of the procedure” with this year’s CPT updates. Providers who perform moderate sedation with a procedure must report the appropriate new moderate sedation codes to receive full reimbursement. As a result of removing this long time bundling edit, many procedures will see a slight reduction in RVU.n
Effective Jan. 1st, CMS will begin paying for complex CCM services (99487-99489) in addition to normal CCM (99490). These CPT codes have been around for a while, but CMS has always refused to reimburse for them. Keep in mind, to get paid, you must be able to properly note all the moving parts of this service in the medical record as indicated by the coding guidelines.nnCMS has also created a new add-on G code — G0506 (Comprehensive assessment of and care planning for patients requiring chronic care management services [List separately in addition to primary monthly care management service]).nnIt covers the additional work associated with assessing CCM services and generating a care plan. This used to be bundled into payment for an office visit (99201-99215), but in 2017 you can get paid EXTRA for it if you nail down your documentation. You’ll also find relaxed billing rules for CCM services in 2017, which include getting rid of a beneficiary consent form and removing the requirement for 24/7 access to care.n