Reimbursement

Perhaps the biggest consumer problem Obamacare has is that the plans with high premiums even after the subsidy, big deductibles, and narrow networks are not attractive to working class and middle class families and individuals who don't qualify for the biggest tax credits.

Incorporating federal sequestration into Medicare Advantage provider reimbursement has spurred a new lawsuit, and one that could spell trouble for other plans.

When it comes to speeding up the revenue cycle, the hospital pharmacy has its own part to play.

With new incentives, hospitals are increasingly making the reduction of complications, infections and readmissions a priority, but there are still infrastructure gaps that can tangle payer-provider collaboration.

In recent years, there has been an incredible transformation in the healthcare industry, especially in the role of consumers. A decade ago, health plans worked with employers to manage almost all health benefit decisions, leaving consumers relatively unaware of the costs associated with their healthcare needs. Not so today.

While some state exchange executives exited their exchanges amid foundering technology and low public esteem, the director of one successful state HIX has landed in the growing private exchange unit of a large national insurer.

Ahead of the next open enrollment period, federal regulators are trying to clarify rules for member non-payment and grace periods, but insurers and providers may still have lingering concerns about getting paid.

As payers and employers put pressure on providers to assume more financial risk, providers are struggling to assess the impact of the risk they have already assumed.

Americans across the country may be pleasantly surprised to get a small check from their health plans this summer, but insurers may need to plan better if they want avoid an administrative hassle.

The nation's largest health insurer is making its free mobile app available to everyone, in a bid to move the needle on price transparency.