Providers and their payers oftentimes have a love-hate relationship. Payers boost the number of patients walking through physician office doors using provider directories as well as reimburse providers...
Freestanding emergency departments (EDs) may be altering the payer mix at the equivalent hospital-based facility because the freestanding EDs tend to be located in areas with greater household incomes...
WASHINGTON DC - The move to integrated care models that treat the whole individual, not just his medical needs, rests on payer and provider collaboration as well as linking healthcare and lifestyle,...
WASHINGTON DC – Social determinants of health has emerged as a major theme at America's Health Insurance Plans’ (AHIP) National Conferences on Medicare, Medicaid, and dual eligibles in...
Value-based reimbursement arrangements come in a myriad of shapes and sizes much like provider organizations. But successful value-based contracts will align provider and payer goals for care quality...
Approximately 86 percent of medical practice leaders reported that prior authorization requirements have increased over the past year, a recent MGMA survey of over 1,000 leaders found.
Only 3 percent...
Healthcare providers still lack the necessary tools for value-based purchasing success with only 43 percent of providers reporting that they have access to the appropriate solutions, a recent Quest...
Earlier this week, Tennessee Governor Bill Haslam signed the Provider Stability Act into law, which intends to increase transparency and accountability for payer contract management.
Effective Jan. 1,...
ORLANDO - Prior authorization reform has recently been a hot topic for many healthcare industry groups and it was no different at HIMSS17.
To find out more about what providers and payers plan on...
With a possible full or partial Affordable Care Act repeal in the near future, healthcare executives called for some of the healthcare reform law’s provisions to continue, such as increased...
Every dollar counts in the healthcare revenue cycle, especially with declining Medicare reimbursement rates and new value-based care models. But organizations should understand how to successfully...
Aetna was awarded $37.4 million in a lawsuit against Bay Area Surgical Management and a group of surgical centers, which allegedly conducted various types of healthcare fraud, including overbilling and...
Accountable care organizations (ACO) hold the key to successfully implementing value-based care and receiving value-based reimbursement. However, delivering quality care while also preparing for...
When the novel The Hunt for Red October was first published, it did more than elevate Tom Clancy from obscure real estate agent to international best-selling author. It also introduced readers to the...
With the deadline for filing this year’s taxes just around the corner, it is useful for insurance consumers to refresh the requirements of tax filing when covered through the health insurance...
Congress has passed a two-year delay of the Cadillac Tax – a 40% non-deductible tax on the cost of employer-sponsored health coverage that surpasses specific benefit thresholds, part of the Omnibus...
The Affordable Care Act (ACA) has come a long way over the past 12 months. It is intended, as the name implies, to make health insurance more affordable and make sure more patients greater levels of...
The Affordable Care Act (ACA) aims to increase the number of people with health insurance by expanding Medicaid coverage nationwide. Are targets being hit or merely glossed over?
Medicare Part D...
What do Manhattan rents, Ferraris, college tuition, and chronic disease all have in common? They are all really expensive.
What is especially problematic is that chronic diseases are not only very...
Misunderstandings swirl as the Affordable Care Act’s (ACA) ever evolving ability to reduce the number of uninsured adults is continuously called into question.
The total number of adults who have...
