Reimbursement
Health insurers' most profitable book of business may be on the way out. If the projections of Fortune 500 companies are to be believed, the next half-decade will be sink-or-swim to the other end of evolving exchange markets.
As health insurers adjust to a shifting regulatory landscape and changes in reimbursement, many have considered adopting restrictive formularies or new policies aimed at managing the usage of high-cost medications. While more restrictive formularies or policies for usage may temporarily cut costs, they can have serious health consequences for patients and can actually end up costing payers more in the long run.
The annual PayerView Report, from health IT company athenahealth, reveals the healthcare payer that has the best relationship with providers and the one that has the most problems.
Medicare Advantage insurers may soon find themselves facing new public scrutiny over potential spending and overpayment discrepancies.
The HEDIS reporting deadline is Monday, June 16. Here is an adage to guide health plans through the reporting season.
In the search for meaningful patient care improvements and sustainable financing, some independent physician groups are charting unique approaches that may offer models for payers and providers in the age of cost-containment and risk-sharing.
For the second year in a row, Humana ranked first in overall performance among 148 payers, according to the 2014 PayerView Report. The report ranks health insurers according to specific measures of financial, administrative and transactional performance.
States, insurers and self-funded employers are facing mounting pressure to expand autism coverage, but some may be too slow for advocates.
The federal government and a number of hospitals may want to transition to a new Medicare reimbursement model. But there are still billions of dollars in disputed fee-for-service claims waiting to be settled.
One of the biggest beneficiaries of healthcare reform's expansion of insurance coverage to more than 13 million people this year has been the nation's safety-net hospitals. At least in the states that have chosen to accept the Medicaid expansion.