Reimbursement

Hospitals in states that don’t expand their Medicaid program as outlined under the Affordable Care Act are facing significant revenue reductions due to regulations that will reduce some Medicare and Medicaid payments in 2014, measures that were written into the law to help pay for the expansion of the insurance program for the poor.

Although physicians have always valued prompt, accurate and complete claims payment, the need for such payment has become more important as physician practices try to balance increasing costs with shrinking reimbursement.

The Workgroup for Electronic Data Interchange announced Thursday that it had submitted its ICD-10 industry readiness survey to the Centers for Medicare & Medicaid Services. Its findings continue to show insufficient readiness for the October 2014 transition deadline.

In most states, the difference between premium rates for young and old members is already largely within the 3:1 ratio set by the Affordable Care Act, according to a new study by the consumer website Health Pocket.

With the Affordable Care Act entering the home stretch of implementation, U.S. Senators are still trying to understand the costs and benefits of market reforms, while diagnosing problems in the greater healthcare system.

Baptist Health Madisonville, in Madisonville, Ky., announced Thursday that it has begun work with TransforMED, a Patient-Centered Medical Home transformation program, to improve primary healthcare for its patients in western Kentucky.

Two of the nation's leading forces in health insurance -- UnitedHealthcare and the Blue Cross and Blue Shield Association -- will face off Thursday before a congressional subcommittee in a battle for control of the $47 billion program that covers 8 million federal employees, retirees and their families.

As President Barack Obama takes his budget and deficit-reduction proposals to Congress and the public, the Department of Health and Human Services has unveiled its proposed budget for the 2014 fiscal year.

In Europe, reimbursement decisions for drugs often include explicit consideration of cost effectiveness and a comparison of the efficacy of the new drug with products that are already available.

The former head of Massachusetts' health insurance exchange thinks that advertising and outreach will make or break the enrollment success of federal and state-based HIXs.