Reimbursement
Challenging Highmark's cuts to cancer payments, UPMC is playing the long-game in being the provider of choice for western Pennsylvania's seniors.
Despite some lulls, the war between the University of Pittsburgh Medical Center and Highmark is again raging, now with a battle over Medicare Advantage plans and oncology reimbursement.
How far can private exchanges go? New data suggest a large migration is in the works, even as the model brings some uncertainties for employers and insurers.
To fix financial woes, New York City's taxpayer-owned health system is plotting a comeback and planning to give more residents a kind of public option for health insurance.
As consumers increasingly are being asked to pay a larger share of their health bills, a coalition of insurers, pharmaceutical companies and provider and consumer advocacy groups launched a new push for greater transparency about the actual costs of services.
Employer health plans have seen significant benefit design changes in the past few years, due to rising healthcare costs and the Affordable Care Act. As actuaries analyze historical medical cost trend in order to forecast future trends and analyze the impact of benefit design changes, the effect of the member behavioral phenomena known as "benefit rush," "benefit hush" and "trend crush" should be considered.
For outpatients who receive care on both Sept. 30 and Oct. 1, the challenge will billing under both ICD-9 and ICD-10 diagnostic coding vocabularies.
In their ongoing efforts to manage costs and improve profits, many health plans are turning to the area of claims payment integrity, seeking opportunities to reduce annual claims expense by millions of dollars.
The Blue Cross Blue Shield brand may bring the idea of a consistent kind of health insurance, as the winner of one "health plan brand of the year" poll. But in Medicare Advantage satisfaction ratings, that is not the case.
Just as rival Humana exits the market, UnitedHealth Group is growing its portfolio of retail health clinics, in another step towards insurer-owned healthcare delivery.