Reimbursement

A group of chiropractors went to war with the Blues and it seems they've won, successfully using a novel legal theory that now has lawyers setting their sights on other large insurers.

Kaiser Permanente is hiring an integrated care specialist but organizational outsider as its new chief medical officer, as the focus on innovation comes to the fore.

As the Affordable Care Act continues to disrupt the health insurance industry, health plans must broaden their definition of risk as they calculate rates and attempt to better understand their members' needs.

The House of Representatives passed a bill yesterday to forestall scheduled cuts to Medicare physician payments through April 1, 2015, to delay the ICD-10 implementation deadline for one year, and to suspend enforcement of the controversial two-midnight policy.

As the quality and cost transparency movements gain support within the healthcare industry, a more important question persists: what will actually work for consumers?

The many moving parts in the government's ACA plan transition policies are creating a range of new complexities for premium pricing, member pools and the new risk-sharing programs.

All but five states received a failing grade this year on the way they provide healthcare price transparency, according to a report by Catalyst for Payment Reform and the Health Care Incentives Improvement Institute.

Only five states states are making headway bringing more price transparency to healthcare markets, but they could be a model for others, especially those with all-payer claims databases.

The federal government is promising that anyone who wants to buy subsidized insurance will be able to as long as they try to enroll before March 31. But insurers should expect more surprises and lingering work from complex cases.

The executive who ran IT for Coca Cola is coming to WellPoint to oversee and optimize technology across health plans and other, evolving businesses, including one advanced project with high expectations.