Healthcare Finance Staff
Amid new skepticism of back pain treatments, one of the largest medical device makers is being sued for a product that brought in close to one billion dollars annually at its peak while increasing risks for patients.
The practice of taxing Medicaid managed care organizations to raise revenue for state-share payments has left some auditors scratching their heads, raising questions that could shake up financing models.
Among all of the public money that federal healthcare watchdogs are trying to follow is a lot that will continue to be devoted to marketplaces and tax credits.
Around the country, narrow provider networks are sparking consumer backlashes, prompting regulatory intervention and also raising questions about the value of current insurance designs.
Health insurers' most profitable book of business may be on the way out. If the projections of Fortune 500 companies are to be believed, the next half-decade will be sink-or-swim to the other end of evolving exchange markets.
As health insurers adjust to a shifting regulatory landscape and changes in reimbursement, many have considered adopting restrictive formularies or new policies aimed at managing the usage of high-cost medications. While more restrictive formularies or policies for usage may temporarily cut costs, they can have serious health consequences for patients and can actually end up costing payers more in the long run.
The annual PayerView Report, from health IT company athenahealth, reveals the healthcare payer that has the best relationship with providers and the one that has the most problems.
Medicare Advantage insurers may soon find themselves facing new public scrutiny over potential spending and overpayment discrepancies.
The HEDIS reporting deadline is Monday, June 16. Here is an adage to guide health plans through the reporting season.
In the search for meaningful patient care improvements and sustainable financing, some independent physician groups are charting unique approaches that may offer models for payers and providers in the age of cost-containment and risk-sharing.