Reimbursement

Geographic Medicare costs disparities have more to do with health differences across communities than with inefficient care delivery, according to a new study from the Center for Studying Health System Change.

According to the results of a study published Tuesday in Annals of Emergency Medicine, disabled Medicare patients under age 65 who are unable to take their prescription medications due to cost concerns are more likely to visit the emergency department at least once during the course of a year.

According to the results of a study published Tuesday in Annals of Emergency Medicine, disabled Medicare patients under age 65 who are unable to take their prescription medications due to cost concerns are more likely to visit the emergency department at least once during the course of a year.

The Vermont Department of Financial Regulation has rejected the licensing application of the Vermont Health CO-OP, finding "an extremely high risk of insolvency" and effectively barring the CO-OP from selling on the state insurance exchange this year.

Last week, Parkland Memorial Hospital in Dallas announced an agreement to pay a $1.4 million settlement to the United States Department of Justice over Medicare and Medicaid fraud allegations.

Covered California, soon to be the nation's largest state insurance exchange, is touting the relatively low premium rates tentatively secured for individual health plans -- but HIX officials are comparing those to existing small group market rates, which isn't entirely apt.

Claims overpayments are more than a nuisance; they are an epidemic. Between $68 and $226 billion is lost annually to Fraud, Waste and Abuse (FWA), according to the National Health Care Anti-Fraud Association (NHCAA). As much as 10 percent of healthcare spending is attributed to abuse alone, with the federal government losing more than $70 billion to improper Medicare and Medicaid payments in 2010.

In the first disclosure of individual health insurance premiums by the nation's largest state, California announced on Thursday a wide array of choices for the 5.3 million people expected to qualify to purchase coverage through its online marketplace established by the Affordable Care Act. 

Health insurers in Oregon, one of the nation's most competitive markets, have proposed premium rates for 2014, as most prepare for what may be even more competition in the state insurance exchange.

The Centers for Medicare & Medicaid Services has finalized medical loss ratio regulations for Medicare Advantage and Medicare prescription drug insurers, allowing some EHR and ICD-10 set-up costs to be counted as quality improvement and also a range of deductible community benefit expenditures.