One of the first items for Ms. Burwell is to consider is a June 4, 2014, letter from her advisory group WEDI urging an the adoption of an industry roadmap for implementing the ICD-10 code set now set for October 1, 2015. Heallthcare Data Management reports that
Last week, the Centers for Medicare and Medicaid Services announced that the partial code freeze for ICD-9-CM and ICD-10 will continue through October 1, 2015. And, last month, CMS canceled limited end-to-end testing that had been scheduled for late July, when a small sample group of providers were to have been given the opportunity to participate in end-to-end testing with Medicare Administrative Contractors and the Common Electronic Data Interchange contractor.
“We believe the canceling of the limited July ‘end-to-end’ testing sent the wrong message to the industry. Rather than delay this critical form of testing until 2015, we recommend expediting and expanding this form of trading partner testing,” states [WEDI Chairman Jim] Daley.
Sun Life Financial, an insurance company, released yesterday an interesting report on its health plan stop loss claims experience.
The U.S. business group of Sun Life Financial, Inc. (NYSE: SLF, TSX: SLF) today reported a tenfold rise in the number of individual $1 million or more catastrophic claims paid by the company over the past four years. These findings are based on a study released today by Sun Life Financial U.S., the largest independent writer of stop-loss insurance in the U.S., with $915 million of in-force premium as of December 31, 2013.
The most significant rise related to complications surrounding dependent infants, including premature births, failure to thrive newborns and congenital anomalies, according to Sun Life. While there was no single explicit driver for the increase in these particular complications, Sun Life continues to monitor the underlying business, specific claims, and potential trends related to health care costs and demographics. The Company also notes that these diagnoses often stemmed from normal pregnancies that unexpectedly turned into catastrophic claims, reinforcing the need for protection against “unpredictable” catastrophic claims.