Reimbursement

While public confusion over the Affordable Care Act continues, according to a recent Kaiser Family Foundation survey, Americans tend to trust some sources of information more than others -- including clinicians still grappling with the law's ramifications.

It's no secret: The U.S. healthcare environment is changing swiftly and dramatically. Healthcare organizations are steadily moving away from longstanding, traditional fee-for-service models to value-based care and reimbursement models.

Nurse practitioners say efforts to expand primary care to millions of Americans under the health law are hampered by insurance industry practices that limit or exclude their participation.

Mississippi's Insurance Department will likely be running the small business portion of the otherwise federally-managed insurance exchange serving state residents -- even as the insurance commissioner and other state officials make it clear they're not fond of the rest of the Affordable Care Act.

Contractors hired by Medicare to audit the payment records of healthcare providers have a good track record spotting improper billing, the HHS Inspector General concluded in a recent report, but legitimate concerns about their efficacy exist.

One impending deadline of the Affordable Care Act that flies under the radar is the one in which payers must comply with the mandate on electronic claims reimbursement.

States could potentially save millions if they adopted the Medicare competitive bidding payment amounts to purchase medical equipment instead of the higher Medicaid fee schedule amounts, according to a recent report from the Department of Health and Human Services Office of Inspector General (OIG).

A recent survey by the health rewards marketing company EveryMove indicates health insurers aren't fully embracing mobile technology -- a critical strategy as the nation moves toward mandatory health information exchanges. Blue Cross Blue Shield of Michigan is making a move to stay ahead of the curve.

California Governor Jerry Brown is deciding whether to sign a bill regulating quasi-generic versions of specialty biologic drugs known as biosimilars -- and some provisions have raised cost and access concerns among health payers like the California Public Employee Retirement System.

Contractors hired by Medicare to audit payment records have a good track record spotting improper billing, the Department of Health and Human Services Inspector General concluded in a report, but some legislators and providers still have concerns.