Reimbursement

There are two ways of thinking about, and therefore measuring, the rate of hospital readmissions, and they often lead to quite different results and quite different decisions on Medicare penalties.

One Medicare Advantage company offers a parable for what can go wrong in the business of managed healthcare.

A fractious and potentially costly family of provider-led class action lawsuits are moving through courts, pitting accusations of illegal clawbacks againsts the likes of Aetna and UnitedHealth Group.

More than 1 million people selected a health plan during the fourth week of the health law's open enrollment and nearly 2.5 million have done so since it began Nov. 15, federal officials said Tuesday.

More than $665 million will be distributed to states around the country to test new service and payment models, the U.S. Department of Health and Human Services said Tuesday.

Private physician practices may soon be a thing of the past, according to a new survey that shows them dwindling year over year as more doctors opt to become part of a hospital or health system.

Independent Bill Walker, who won election last month in a governor's race so tight the results weren't known a week after the voting was over, campaigned on the promise that he'd expand Medicaid as one of his first orders of business.

WellCare has been trying to shake off its past transgressions and grow amid speculation of being a target for acquisition, and now its executive suite is ready for business.

The pressure is growing on Republican Governors to expand Medicaid in some way, and more state executives are turning to managed care and market-based approaches to bring in federal dollars.

Tennessee Gov. Bill Haslam this week proposed a "private option" Medicaid expansion policy for the state, the latest Republican state executive to back a managed care or market-based approach to bring in federal dollars.