Reimbursement

The corporate saga of a Medicaid managed care fraud case is coming to a close as three former executives head to federal prison, offering a cautionary tale for public benefits contracting.

Just in time for plan application and premium rating season, federal regulators have finalized market policies for the ACA's second open enrollment period, while continuing the tradition of leaving a few important issues to-be-determined.

In this video from The Texas Tribune, Becca Aaronson reports on a state investigation into misspent Medicaid dollars after Texas spent more on Medicaid orthodontic services from 2008 to 2010 than the other nine most populous states in the nation.

If global spending becomes the norm in Medicaid, health systems, medical practices, home health and community organizations will face an even greater impetus to collaborate. In the Empire State, some are already starting the journey.

Last week, the Centers for Medicare & Medicaid Services published a final rule that reforms federal health policy regulations that CMS has identified as unnecessary, obsolete, or excessively burdensome on healthcare providers and suppliers. Here are some highlights.

Value-based purchasing introduces the potential for unintended consequences, and needs to be monitored to avoid disparities between hospitals. But it's too early to claim that VBP puts disproportionate share hospitals at a disadvantage.

According to a study published this week in Health Affairs, the Great Recession did not have a permanent negative financial impact on vulnerable hospitals, such as safety net facilities, or those considered financially weak prior to the recession. However, this doesn't mean these same hospitals will fare so well in coming years.

A media specialist who shares roots with Affordable Care Act foes is taking the communications helm of AHIP, tasked with defending an industry in transition and often under scrutiny for narrow networks and premium affordability.

In a changing healthcare economy, commercial payers have to re-evaluate how they do business with hospitals in order to contain costs while also meeting the demands of their members, many of whom are seeking expensive surgeries such as knee and hip replacements.

As an alternative to traditional eligibility expansion, one Republican hopes to bring consumer-directed insurance to Medicaid while also bridging a gap in the lower end of the group insurance market.