Reimbursement

Insurers that have submitted applications to sell exchange plans are currently waiting, hoping regulators will approve their premiums and that consumers will find them affordable, in what will be a more crowded marketplace.

The state of Illinois is nailing down key Medicaid policies ahead of a massive managed care rollout and accountable care experiment.

WellPoint has won the right to challenge a hospital's chargemaster billing practices, but the ultimate resolution could still disrupt relations with a key provider in a large market.

MedPAC is out with its 15th annual mid-year report, offering advice for Congress and the Department of Health and Human Services to improve and sustain the senior's health program as it enrolls millions of retiring baby boomers. Here's what hospitals need to know about the commission's latest thinking.

A health plan and a health system are preparing for the rise of capitation in Medicaid with a new care management venture, as more state programs try to phase out fee-for-service.

How do hospitals survive if they keep patients healthy and at home? For New Hampshire’s New London Hospital, the answer is to partner with the largest hospital in the state to keep costs low and possibly boost patient volume.

Pressure is growing on insurers to stop using mail-order pharmacies for speciality medications, and also on benefits managers to find new ways to get lower drug prices.

Even amid delays in enforcement of the Affordable Care Act's employer mandate, tax and reporting regulations are sowing confusion among employers and putting large businesses on edge.

Two accountable care networks spanning three health systems have landed contracts with one of the country's largest private employers, in a model that could leave traditional players behind.

"Clinical integration" and "organizing for value" are two key themes at the HFMA 2014 ANI conference. Both are crucial in preparation for the transition from a fee-for-service reimbursement system. Here's an example of how one health system is preparing, by teaming with a health plan on a new care management venture.