Reimbursement
One of the main culprits is the "buy-and-bill" reimbursement model for infused therapies.
Optum likely to run healthcare arm if buy-out goes through, leveraging the Advisory Board's provider relationships and Crimson dataset.
While certain programs favor large systems, plenty of providers are proving that scale doesn't always matter.
If states impose lifetime caps and eliminate essential benefits, questions of how much an insurer pays for services remains uncertain.
The contract fall-out means Blue Cross members will no longer have insurance coverage for most services provided at Children's facilities.
For the first time this week, the Centers for Medicare and Medicaid Services was scheduled to make public encounter data on Medicare Advantage plans.
To avoid over-burdening physicians, providers must align non-competing interests and minimize the administrative burden of multiple payment models, authors say.
Only 8 percent describe themselves as "deeply knowledgeable" about the program and its requirements, the survey said.
The American Diabetes Association does not recommend the treatment and Medicare's review of the therapy for diabetic wounds owes more to hospitals' pursuit of revenue than to the treatment's proven value.
Recovery effort came with a price tag of roughly $118 per claim, or as much as $8.6 billion in appeals-related administrative costs, Change Healthcare said.