Healthcare Payers

Surprise Billing Arbitration Favors Providers, But Rates Are High

by Jacqueline LaPointe

An out-of-network surprise billing solution in New Jersey favors providers, paying them significantly more than in-network prices for the set of services in dispute, according to a new Health Affairs...

Payers, Providers Need Data to Talk Value-Based Care

by Jacqueline LaPointe

The definition of value is evolving, and so are the capabilities needed to support the transition to value-based care, industry experts recently shared at Xtelligent Healthcare Media’s...

Most Physicians Prefer Single-Payer Option Over Medicare For All

by Jacqueline LaPointe

Providing affordable health insurance coverage is a top goal for physicians and most believe healthcare can achieve that through a single-payer option, a new survey reveals. The final installment of...

A Unique IPA Centers on Social Determinants of Health

by Jacqueline LaPointe

More and more healthcare providers and payers are teaming up with ride-sharing companies, food pantries, and other community-based organizations to address one of the largest drivers of patient...

Private Payers Outpace Public Insurance in Value-Based Care Push

by Emily Sokol, MPH

Private payers are leading the charge away from fee-for-service reimbursement. These parties are more likely than public payers to participate in value-based reimbursement models, according to the...

Multi-Payer Alignment Key to Advancing Value-Based Care in Medicaid

by Jacqueline LaPointe

In a new letter to Medicaid directors, CMS called for multi-payer alignment in value-based care arrangements run by the state healthcare programs. The Sept. 15th letter providers guidance to the...

Providers Price Gouging Out-of-Network COVID-19 Tests, AHIP Says

by Jacqueline LaPointe

America’s Health Insurance Plans (AHIP) is calling on the government to stop price gouging after finding provider prices for out-of-network COVID-19 tests far exceeded the average cost of...

Medicaid Enrollment Grew by 2.3M People at Start of the Pandemic

by Jacqueline LaPointe

In the first several months of the COVID-19 pandemic, Medicaid enrollment increased by at least 2.3 million Americans, according to researchers from the University of Minnesota. For more coronavirus...

Mending Payer Relations Smooths Revenue Cycle at Northwestern Med

by Jacqueline LaPointe

Payers and providers have existed on different sides of the same fence, meeting in the middle once or twice a year to negotiate contracts or resolve major issues. However, technology, revenue cycle...

42% of Anesthesiologists Had Contracts Terminated in Last 6 Months

by Jacqueline LaPointe

Anesthesiologists are being forced out of network as private insurers terminate their physician contracts with little to no notice, according to a recent survey conducted by the American Society of...

Claims Reimbursement Changes Notably Reduce Low-Value Care

by Samantha McGrail

A greater reduction in low-value vitamin D screening was associated with a claims reimbursement change related to recommendations, according to a recent study. Published in JAMA Network Open on...

Providers Lagging with Value-Based Care, Consumer Strategy

by Jacqueline LaPointe

When it comes to adopting value-based care and developing a consumer strategy, providers are significantly further behind compared to payers, according to the tenth annual Industry Pulse Report from...

Physicians Propose 5 Quality Measures to Improve Medical Billing

by Samantha McGrail

Medical billing quality is a type of medical quality and should be tracked the same way healthcare organizations track medical complication rates and other quality indicators, two physicians from Johns...

Commercial Payer Spent $5.5B on Low-Value Care Services

by Samantha McGrail

Nearly $5.5 billion was spent on 20 low-value care services in 2015, according to an analysis of health care claims from the Research Consortium for Health Care Value Assessment. The analysis, funded...

One-Third of Providers Believe Payer Audits Are a Burden

by Samantha McGrail

Nearly one-third of providers report a negative experience with payer audits, with one in ten reporting that they spend over $1 million in administrative costs annually, according to a recent Frost and...

Prior Authorization Costs Rise as Electronic Adoption Remains Low

by Jacqueline LaPointe

Prior authorization costs accounted for just two percent of overall medical industry spending on administrative transactions in 2019, but the process was the most costly, time-consuming transaction for...

Providers Spend $2.76B Annually on Provider Directory Maintenance

by Samantha McGrail

Nationally, provider directory maintenance cost physician practices about $2.76 billion each year, with each practice spending $998.84 on average every month, according to a recent survey conducted by...

AHA, Others to Sue HHS Over New Hospital Price Transparency Rule

by Samantha McGrail

The AHA announced its decision to sue HHS over the recently finalized hospital price transparency rule, which will require hospitals to disclose their payer-specific negated rates to consumers,...

Radiation Oncology Bundle Inaccurately Predicts Some Cancer Costs

by Samantha McGrail

A proposed bundled payment model for radiation oncology cold underestimate payments for prostate cancer, a new analysis from Avalere,  finds.  The healthcare consulting firm based in...

Partners, Patients Key to Achieving Value-Based Care Results

by Jacqueline LaPointe

For over a decade, the healthcare industry has been shifting provider reimbursement from a fee-for-service system to one based on the value of services provided to patients, and new payment models have...