Reimbursement

As giants like Blue Cross Blue Shield, Aetna and Humana target smartphone access, the payers must think hard about the kind of experience they're offering patients through an app.

The nature of the risk under the CMS Pioneer ACO and Shared Savings programs is hard for providers to manage. But the Next Generation ACO program has changed the level of risk, offering providers a higher share of savings and new ways to limit unpredictable losses.

The further reimbursement cuts are expected push margins of an estimated 40 percent of all home health providers into loss territory.

As dry as the decision may appear, insurers literally have millions of dollars on the line when CMS comes knocking. That makes picking the right auditor, and doing so the first time, absolutely critical.

The chief lobbyist for American health insurance is taking a job at a regional nonprofit insurer, after shaping a once-in-a-generation reform aimed at benefiting both the public and the industry.

It was only a matter of time until a big regional Blue Cross insurer got hacked, except that time was a year ago and security experts just recently uncovered it.

Depending on how much the program is reformed, it could mean the difference of hundreds of millions of dollars for the thousands of hospitals who get a drug discount.

The decline of CoOportunity Health of Iowa and Nebraska has Obamacare critics and executives at large insurers skeptical that co-ops can ever compete.

Aetna has found itself in the odd position of being fined for covering something some members wanted, while not being fully up to speed covering another condition.

The Advisory Board revenue cycle head Ed Hock says punting on ICD-10 until the new code set is ready robs healthcare providers of the benefits of the Oct. 1 changeover.