Reimbursement

Blue Cross and Blue Shield companies are making progress in its transition from fee-for-service to value-based reimbursement models.

With federal rules governing health plan spending looking like they're here to stay, insurers are making inroads on compliance, although they will hope for possible tweaks in the future.

The Affordable Care Act included a number of delivery system reforms, such as ACOs, bundled payments, and workforce provisions to strengthen foundations in primary care. Unfortunately, a focused effort on payments for specialists was not included.

As Affordable Care Act exchanges bring health plans to previously uninsured Americans, there are also market segment transitions that could prove favorable for risk pools.

Trying to help transition the American healthcare system beyond fee-for-service, Blue Cross and Blue Shield companies are starting to reach new reimbursement milestones.

Medicare regulators are updating hospital outpatient and ambulatory surgery center payments for next year, and also outlining a potential remedy to private Medicare overpayments.

UnitedHealthcare's bid to change financial incentives for oncologists has led to some promising, though somewhat mixed results.

A new study says there's no need to worry about hospitals using their new electronic medical records to generate bigger bills and boost their income, but the study may not be checking the right data.

Joining its peers in touting accountable care, Cigna has met a fairly ambitious goal set two years ago, but more time is needed to test the strategy's sustainability.

One regional insurer is using a new approach in provider network management, as it aims to tackle a laborious administrative process.