Reimbursement
So far, 2014 is not looking too shabby for some large insurers. Aetna, the Hartford-based giant, raised its outlook following a record quarter, but that doesn't mean there aren't headwinds.
A small uproar over provider networks in public insurance exchanges in Washington state has led to a proposed, controversial fix that, if adopted, has implications for other states, providers and insurers facing similar situations.
The billing (claims) data of healthcare providers for the United States Medicare Program, which is considered to be one of the most important healthcare programs to be held private for almost 35 years, was made available to the public just a couple of weeks ago on April 9.
The brains behind implementing much of the Affordable Care Act's new Medicare policies, Jonathan Blum, principal deputy administrator at the Centers for Medicare & Medicaid Services, will be stepping down from his position on May 16.
Midwest managed care insurer Centene is on a roll. It beat Wall Street's first quarter expectations, increased membership and has its eyes on a new international venture.
Many claims processing organizations rely on distributed workforces to save costs on office space, increase their access to labor, and have a broader talent pool to recruit out of. There are plenty of benefits of this approach, but there are also risks.
Healthcare has a few things to do differently in the privacy and security arena -- one of them being: Start taking it seriously.
The first state to use Medicaid expansion funding for private exchange insurance has attracted well over half of all eligible beneficiaries, with a healthy mix in the risk pool.
Fears about public exchanges threatening established insurers may have been exaggerated, at least in the country's largest ACA marketplace.
Leaders from the Centers for Medicare & Medicaid Services think private insurers have been too slow to adopt payment reforms, but they would be best served by adopting value-based payment systems in tandem with CMS today.