Reimbursement

Although accountable care organizations are still in their nascent stages, a few large provider groups and payers may be ahead of the curve on operations and performance.

Next year, when Americans go looking for the best surgeon or cheapest MRI, many will have free access to a new comparison service started by three insurance giants.

Several million young people purchasing subsidized exchange plans was greated as a positive development for all involved. But being young does not mean being free from chronic or acute illness, as early data on one insurer's new enrollees shows.

With a new fiscal year approaching in many states, a big financial cloud is hanging over Medicaid managed care organizations: the Affordable Care Act's insurance fee.

Twenty-four states, including almost the whole South, took the stubborn path and have so far refused to expand Medicaid. That's a big reason rural hospitals are continuing to struggle.

An extension of presumptive eligibility coverage takes away Medicaid payment uncertainty if hospitals make the effort to participate and follow the rules.

Modernizing code is essential for payers as technology ages and healthcare evolves. How does it work, and what's on the line?

Of the 24 federally-supported cooperative insurers, one is off to a somewhat disruptive start in the Blue Cross-dominated insurance markets of Iowa and Nebraska.

A new Medicare prospective payment system for federally qualified health centers offers improved reimbursement rates.

Their rates may be somewhat low, but Blues plans tend to pay on time and can be trusted, a survey of health system executives found. Not so for other large insurers.