Reimbursement

The National Women's Law Center (NWLC) has filed federal discrimination complaints against five large employers, arguing that their exclusion of pregnancy coverage in health benefits for dependent children violates the Affordable Care Act's nondiscrimination provisions.

Adding more mixed evidence to the Medicaid expansion debate, health researchers found that extending coverage to low-income, childless adults in Wisconsin corresponded with a decrease in preventable hospitalizations but also increases in outpatient and emergency department visits.

Adding more mixed evidence to the Medicaid expansion debate, health researchers found that extending coverage to low-income, childless adults in Wisconsin corresponded with a decrease in preventable hospitalizations but also increases in outpatient and emergency department visits.

The 2013 AHIP Institute will have special significance this year, with the annual gathering taking place shortly before major components of the Affordable Care Act are activated.

The New Hampshire Governor's Commission on Medicaid Care Management is recommending expanding Medicaid eligibility under the Affordable Care Act, "due to its necessity" in transitioning the state's Medicaid program from fee-for-service to managed care.

As the country gets ready for the roll out of the major components of the Affordable Care Act, stakeholders can look to Massachusetts, where healthcare reform was enacted seven years ago. The second installment of PwC Health Research Institute's The Massachusetts Experience, released Thursday, provides analysis on the effects of rapid insurance coverage expansion on health payers and providers in the state.

The managed care programs of several states profiled in a new Urban Institute report show a range of policy options available as new Medicaid rules and eligibility expansion (in 21 states for now) takes effect next year.

Steven Brill’s Time article, “Bitter Pill” sent a shock wave through the healthcare industry and prompted a response from the American Hospital Association to correct a series of mis-statements and financial assumptions.

Revenue cycle integrity is critical to financial performance and will be even more so with accountable care organizations, bundled payments and other changes coming with healthcare reform.

Evan Schwartz, founding partner of New York-based law firm Quadrino Schwartz, said his organization used to see the occasional case of private insurers retrospectively auditing health care providers – they only litigated about 10 or so each year.