Reimbursement

Earlier this month, CMS published its final rule to update the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System rates and policies for 2015. Here are the highlights.

An Arkansas Medicaid expansion policy may be threatened as new leadership heads to the state capital, despite early reports that show the program is benefiting low-income patients and hospitals alike.

A group of Wall Street analysts predicted Friday that enrollment in Affordable Care Act insurance plans will be higher than the 9 million projected by the Obama administration.

The Medicaid private option policies designed to insure low-income individuals through a more market-based system is showing early signs of success, but also hurdles.

While narrow networks aren't new, they have emerged as one of insurers' major levers for keeping costs down under the Affordable Care Act. Patients are often distressed at narrow networks' restrictions, but such plans can be designed right.

Just days before the Affordable Care Act's marketplaces reopened, nearly a quarter of uninsured said they expect to remain without coverage because they did not think it would be affordable, according to a poll released Friday.

Federal health officials and state exchange leaders may be pleased with enrollment and plan choices in many places, but long-term financing is a puzzle yet to be solved.

Although it may be tempting to rely on the status quo when it comes to payer payment, opportunities exist to boost collections by shifting key activities upfront and leveraging revenue-driving tools and processes on both the front and back ends of the revenue cycle.

Provider network controversies from the first Affordable Care Act enrollment are coming back to bite two large Blues in the second open enrollment, while raising questions about responsibility for consumer confusion.

Accountable care organizations can be risky business. ACO care partners must be able to depend on one another for proper patient handling, data flow, clinical cooperation, revenue sharing and other agreed-upon measures.