Reimbursement

If consumers can not make more informed healthcare decisions, they may just end up being skinned alive.

The nation's second largest insurer is taking some flak for declining a second opinion on its information technology security.

Starting next year, health insurers have to give Americans in Medicare Advantage plans and federal exchange policies up-to-date details about which doctors are in their plans and taking new patients.

An increasingly popular strategy in drug plan affordability is again coming under scrutiny from Medicare regulators concerned that some urban seniors are being left out.

The Catholic Health Care System, aka ArchCare, allowed Medicare to be billed for patient care at the highest therapy-based levels, even though its subcontractor RehabCare, was often not providing therapy at those levels, according to the U.S. Attorney's Office.

Inaccuracies in the Medicare Advantage directories may trigger penalties of up to $25,000 a day per beneficiary or bans on new enrollment and marketing.

Health insurers and patients could get a bit of relief after years of paying more and more for biologic speciality pharmaceuticals, but some think there are still barriers to affordability.

If you read the memo and muttered, "uh-oh" under your breath, you might be thinking that your plan/organization owes CMS some money, and soon. If you haven't read this memo, "uh-oh" would be an understatement.

One of the Bay Area's most popular health systems is expanding its new health plan, trying to craft a unique value proposition in changing times and picking up some notable clients along the way. 

The groups are worried about anticipated failures resulting in a significant, multibillion dollar disruption for physicians and serious access-to-care issues for Medicare patients.