Reimbursement

North of the Mason-Dixon Line, it's hard to find a state that has given more of a cold shoulder to President Barack Obama's health law than Maine.

The Everett Clinic and member-owned healthcare co-op Group Health Cooperative announced this week they would strengthen their existing relationship through an alliance that will create an accountable care organization to serve seniors in Group Health's Medicare Advantage plan.

Now that the election is over and the Affordable Care Act has been made permanent by the Supreme Court's decision, governors who have been sitting on healthcare decisions have "a lot of pent up energy" for moving forward, said former Republican Senate Majority Leader Bill Frist at a post-election healthcare meeting held in Washington, D.C., on Thursday.

With Medicare enrollment and spending set to grow in the coming decades, the program needs to better spread risk and incentivize value and also needs a better statutory definition of cost-benefit considerations, researchers argue in the latest issue of the New England Journal of Medicine.

Helping providers prepare for what some have called a coming reimbursement war, the tech firm SAI Global Compliance has unveiled an application called the "Claims Denial Manager," designed to limit losses from pre-payment claims denials. 

Following the devastation of post-tropical storm Sandy last week, the Centers for Medicare & Medicaid Services (CMS) issued blanket waivers of particular requirements that include all hospitals, skilled nursing facilities, home health agencies, hospice and end-stage renal disease facilities in the areas of New York and New Jersey that were strongly affected by the storm.

Following the devastation of post-tropical storm Sandy, the Centers for Medicare & Medicaid Services (CMS) issued blanket waivers of particular requirements that include all hospitals, skilled nursing facilities, home health agencies, hospice and end-stage renal disease facilities in the areas of New York and New Jersey that were strongly affected by the storm.

Massachusetts has tentatively selected six organizations to participate in a three-year, capitated payment model demonstration for dual eligible patients.

Humana Inc.'s third quarter earnings call was filled with more than just financial results Monday, as it also announced the acquisition of three companies as the company looks to continue building its clinical delivery infrastructure.

Humana Inc. on Monday announced third quarter 2012 earnings of $2.62 per share that were slightly lower than its earnings for $2.67 for the same period last year. Nonetheless, the company's third quarter performance beat both the company's internal guidance and bettered by a sizable margin Wall Street analyst estimates of $2.05 for the quarter.