Reimbursement

Hospitals in Georgia have struggled financially in recent years, as uncompensated care costs rose after the recession and the state rejected Medicaid expansion. But one standalone facility decided that affiliation and clinical integration might be the right path to stave off closure.

For employees, there can be nothing quite like the paperwork of HR and benefits, and for employers it can be expensive, especially with new ACA reporting requirements. Internet companies are trying to cash in on that, and could also shake up the insurance broker business.

Amid new skepticism of back pain treatments, one of the largest medical device makers is being sued for a product that brought in close to one billion dollars annually at its peak while increasing risks for patients.

The practice of taxing Medicaid managed care organizations to raise revenue for state-share payments has left some auditors scratching their heads, raising questions that could shake up financing models.

Among all of the public money that federal healthcare watchdogs are trying to follow is a lot that will continue to be devoted to marketplaces and tax credits.

One third of Pennsylvania's hospitals had negative operating margins in the 2013 fiscal year, according to the Pennsylvania Healthcare Cost Containment Council, an independent state agency. The crisis is forcing health systems to rethink organizational mergers and management.

Around the country, narrow provider networks are sparking consumer backlashes, prompting regulatory intervention and also raising questions about the value of current insurance designs.

Health insurers' most profitable book of business may be on the way out. If the projections of Fortune 500 companies are to be believed, the next half-decade will be sink-or-swim to the other end of evolving exchange markets.

The annual PayerView Report, from health IT company athenahealth, reveals the healthcare payer that has the best relationship with providers and the one that has the most problems.

Medicare Advantage insurers may soon find themselves facing new public scrutiny over potential spending and overpayment discrepancies.